Rosen Melissa R, Truong Tracy, Gervais Catherine, LeBlanc Thomas W, Havrilesky Laura J, Davidson Brittany A
Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, Maryland, USA.
Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA.
Cancer Med. 2025 May;14(9):e70775. doi: 10.1002/cam4.70775.
Patients with incurable cancer deserve quality end-of-life (EOL) care. Despite established EOL quality metrics, many patients receive aggressive EOL care with limited goals of care (GOC) documentation. Concurrently, clinical trials are critical for advancing cancer care. We aim to identify associations between trial enrollment in the last year of life (YOL) and EOL quality metrics for adults with cancer to identify opportunities to advance goal-concordant care.
This is a retrospective review of adult patients with cancer at a single academic institution who died between January 2018 and October 2022. Outcomes included: initiation of a new anticancer therapy, intensive care unit (ICU) admission, hospitalization, or emergency department (ED) encounter in the last 30 days of life (DOL), reception of anti-cancer treatment in the last 14 DOL, referral to hospice, referral to palliative care, and GOC documentation.
Among 9817 patients, 577 (5.9%) enrolled in clinical trials in the last YOL. Patients enrolled in trials were more likely to initiate new anticancer treatments in the last 30 DOL (p = < 0.001), less likely to have a palliative care referral (p = < 0.001) or GOC documentation (p = < 0.001), but were less likely to have an ED encounter in the last 30 DOL (p = 0.04) or die in an acute care setting (p = 0.015).
Enrollment in clinical trials in the last YOL was associated with metrics of aggressive EOL care, with low rates of GOC documentation to determine if this care is goal-concordant. Low rates of palliative care and hospice engagement across the study population suggest opportunities for improvement for all patients, regardless of trial enrollment.
无法治愈的癌症患者应得到优质的临终关怀。尽管有既定的临终质量指标，但许多患者接受了积极的临终关怀，而护理目标（GOC）记录有限。与此同时，临床试验对于推进癌症治疗至关重要。我们旨在确定成年癌症患者生命最后一年（YOL）的试验入组情况与临终质量指标之间的关联，以确定推进目标一致护理的机会。
这是一项对一家学术机构中2018年1月至2022年10月期间死亡的成年癌症患者的回顾性研究。结局指标包括：在生命的最后30天（DOL）开始新的抗癌治疗、入住重症监护病房（ICU）、住院或急诊就诊、在最后14天DOL接受抗癌治疗、转介至临终关怀、转介至姑息治疗以及GOC记录。
在9817名患者中，有577名（5.9%）在生命的最后YOL参加了临床试验。参加试验的患者在最后30天DOL更有可能开始新的抗癌治疗（p = < 0.001），接受姑息治疗转介（p = < 0.001）或GOC记录（p = < 0.001）的可能性较小，但在最后30天DOL急诊就诊的可能性较小（p = 0.04）或在急性护理环境中死亡的可能性较小（p = 0.015）。
生命最后YOL参加临床试验与积极的临终关怀指标相关，GOC记录率低，难以确定这种护理是否与目标一致。整个研究人群中姑息治疗和临终关怀参与率低表明，无论是否参加试验，所有患者都有改进的机会。
