Szilcz Máté, Wastesson Jonas W, Calderón-Larrañaga Amaia, Morin Lucas, Lindman Henrik, Johnell Kristina
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet & Stockholm University, Stockholm, Sweden.
Front Oncol. 2023 Oct 9;13:1223563. doi: 10.3389/fonc.2023.1223563. eCollection 2023.
The appropriate time to discontinue chemotherapy at the end of life has been widely discussed. In contrast, few studies have investigated the patterns of endocrine treatment near death. In this study, we aimed to investigate the end-of-life endocrine treatment patterns of older women with metastatic breast cancer and explore characteristics associated with treatment.
A retrospective cohort study of all older women (age ≥65 years) with hormone receptor-positive breast cancer who died in Sweden, 2016 - 2020. We used routinely collected administrative and health data with national coverage. Treatment initiation was defined as dispensing during the last three months of life with a nine-month washout period, while continuation and discontinuation were assessed by previous use during the same period. We used log-binomial models to explore factors associated with the continuation and initiation of endocrine treatments.
We included 3098 deceased older women with hormone receptor-positive breast cancer (median age 78). Overall, endocrine treatment was continued by 39% and initiated by 5% and of women during their last three months of life, while 31% discontinued and 24% did not use endocrine treatment during their last year of life. Endocrine treatment continuation was more likely among older and less educated women, and among women who had multi-dose drug dispensing, chemotherapy, and CDK4/6 use. Only treatment-related factors were associated with treatment initiation.
More than a third of women with metastatic breast cancer continue endocrine treatments potentially past the point of benefit, whereas late initiation is less frequent. Further research is warranted to determine whether our results reflect overtreatment at the end of life once patients' preferences and survival prognosis are considered.
生命终末期停止化疗的适宜时间已得到广泛讨论。相比之下，很少有研究调查临近死亡时的内分泌治疗模式。在本研究中，我们旨在调查老年转移性乳腺癌女性的临终内分泌治疗模式，并探索与治疗相关的特征。
对2016年至2020年在瑞典死亡的所有年龄≥65岁的激素受体阳性乳腺癌老年女性进行回顾性队列研究。我们使用了全国范围内常规收集的行政和健康数据。治疗开始定义为在生命的最后三个月内配药且有九个月的洗脱期，而延续和停止则根据同期以前的使用情况进行评估。我们使用对数二项模型来探索与内分泌治疗延续和开始相关的因素。
我们纳入了3098名已故的激素受体阳性乳腺癌老年女性（中位年龄78岁）。总体而言，39%的女性在生命的最后三个月内继续接受内分泌治疗，5%的女性开始接受内分泌治疗，而31%的女性停止治疗，24%的女性在生命的最后一年未使用内分泌治疗。年龄较大、受教育程度较低的女性，以及有多次配药、接受化疗和使用CDK4/6的女性更有可能继续接受内分泌治疗。只有与治疗相关的因素与治疗开始有关。
超过三分之一的转移性乳腺癌女性可能在获益期过后仍继续接受内分泌治疗，而晚期开始治疗的情况较少见。一旦考虑到患者的偏好和生存预后，是否我们的结果反映了生命终末期的过度治疗，这值得进一步研究。
