Garg Vikas, Ruiz Buenrostro Alejandra, Heuniken Katrina, Bagnarol Rebecca, Yousef Mohamed, Sajewicz Katrina, Dhanju Suman, Wentlandt Kirsten, Kuruvilla John, Lheureux Stephanie, Zimmermann Camilla, Hannon Breffni
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
Division of Medical Oncology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Cancer Med. 2024 Dec;13(23):e70450. doi: 10.1002/cam4.70450.
Novel systemic anticancer therapies (SACT) in the form of targeted and immunotherapies are increasingly replacing traditional chemotherapy. Little is known about the impact of novel SACT on healthcare resource utilization (HCRU) at the end of life.
A retrospective review of patients attending a tertiary cancer center in Toronto, Canada, with advanced solid or hematological malignancies who died in 2019. Demographic and cancer data, SACT use, HCRU (emergency room [ER] visits, acute/intensive care unit [ICU] admission, and place of death) were retrieved and compared between those who received SACT in their last 30 days of life and those who did not. Chi-squared tests or Quasi-Poisson regression calculated HCRU expressed as percentages or rate ratios (RR). Univariate and multivariable logistic regression identified factors independently associated with SACT use.
Of 443 patients included, 88 (20%) received SACT in the last 30 days of life, with 42 (48%) receiving targeted therapies and 10 (11%) immunotherapy. Factors associated with SACT use included younger age (p = 0.016), breast (p < 0.001), lung (p = 0.047), hematological malignancies (p = 0.002), fewer comorbidities (p = 0.039), and novel SACT (p = 0.006). Receipt of SACT was associated with a higher frequency of ER visits (55% vs. 36% who did not receive SACT, p = 0.001), acute hospitalizations (68% vs. 47%, p < 0.001), ICU admissions (18% vs. 7%, p = 0.003), and death in hospital (45% vs. 30%, p = 0.008).
Novel SACT use at the end of life is high and is strongly associated with HCRU. Future studies should explore the impact of advance care planning and palliative care referrals on SACT use.
以靶向治疗和免疫治疗形式出现的新型全身抗癌疗法（SACT）正越来越多地取代传统化疗。对于新型SACT在生命末期对医疗资源利用（HCRU）的影响，人们知之甚少。
对加拿大多伦多一家三级癌症中心2019年死亡的患有晚期实体或血液恶性肿瘤的患者进行回顾性研究。收集人口统计学和癌症数据、SACT使用情况、HCRU（急诊室就诊、急性/重症监护病房[ICU]入院以及死亡地点），并对生命最后30天接受SACT的患者和未接受SACT的患者进行比较。采用卡方检验或拟泊松回归计算以百分比或率比（RR）表示的HCRU。单因素和多因素逻辑回归确定与SACT使用独立相关的因素。
在纳入的443例患者中，88例（20%）在生命的最后30天接受了SACT，其中42例（48%）接受了靶向治疗，10例（11%）接受了免疫治疗。与SACT使用相关的因素包括年龄较小（p = 0.016）、乳腺癌（p < 0.001）、肺癌（p = 0.047）、血液恶性肿瘤（p = 0.002）、合并症较少（p = 0.039）以及新型SACT（p = 0.006）。接受SACT与更高频率的急诊室就诊（接受SACT的患者为55%，未接受SACT的患者为36%，p = 0.001）、急性住院（68%对47%，p < 0.001）、ICU入院（18%对7%，p = 0.003）以及在医院死亡（分别为45%和30%，p = 0.008）相关。
生命末期新型SACT的使用率较高，且与HCRU密切相关。未来的研究应探讨预先护理计划和姑息治疗转诊对SACT使用的影响。
