Sentana-Lledo Daniel, Barnett Amelia, Einstein David J, Gupta Arjun, Morgans Alicia K
Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, United States.
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States.
Oncologist. 2025 May 8;30(5). doi: 10.1093/oncolo/oyaf046.
Days spent with healthcare contact during cancer treatment, or "time toxicity," may be particularly relevant to patients with end-stage malignancies, including metastatic castrate resistant prostate cancer (mCRPC), considering further cancer-directed therapies near the end-of-life.
We retrospectively assessed healthcare contact days (ie, days with healthcare contact outside the home) in the last 12 months of 96 patients with mCRPC at an academic cancer center. We compared contact days in the 90-day period between 12 and 9 months prior to death ("first quarter") and the 90-day period prior to death ("last quarter") using the Wilcoxon signed rank test, with additional univariate analyses focused on clinicodemographic variables, particularly systemic treatments.
There were higher median [IQR] total contact days in the last vs first quarter (6 [2,17] vs 4 [3,6], P < .01), driven by emergency room visits and hospitalizations. Compared to patients off treatment in the first quarter (4 [3,4]), chemotherapy (5 [4,6], P = .02) and radiotherapeutics (5 [4,9], P = .03) were associated with greater contact days, but not androgen signaling inhibitors (3 [2,5], P = .20). However, there were no differences in contact days by treatment in the last quarter. Patients enrolled in hospice experienced similar contact days between the last and first quarters (4 [2,15] vs 4 [3,7], P = .22).
Patients with mCRPC experienced increased healthcare contact in the last three months of life resulting from higher inpatient level of care, despite most enrolling in hospice. Future studies can further set expectations on time toxicity in end-stage mCRPC.
在癌症治疗期间与医疗保健接触的天数，即“时间毒性”，对于晚期恶性肿瘤患者，包括转移性去势抵抗性前列腺癌（mCRPC）患者而言，在考虑临终前进一步的癌症导向治疗时可能尤为重要。
我们回顾性评估了一家学术癌症中心96例mCRPC患者在过去12个月中的医疗保健接触天数（即在家外与医疗保健接触的天数）。我们使用Wilcoxon符号秩检验比较了死亡前12至9个月的90天期间（“第一季度”）和死亡前90天期间（“最后季度”）的接触天数，并进行了额外的单变量分析，重点关注临床人口统计学变量，特别是全身治疗。
最后一个季度与第一个季度相比，总接触天数的中位数[四分位间距]更高（6[2,17]对4[3,6]，P<0.01），这是由急诊就诊和住院推动的。与第一季度未接受治疗的患者（4[3,4]）相比，化疗（5[4,6]，P = 0.02）和放疗（5[4,9]，P = 0.03）与更多的接触天数相关，但雄激素信号抑制剂则不然（3[2,5]，P = 0.20）。然而，最后一个季度不同治疗方式的接触天数没有差异。入住临终关怀机构的患者在最后一个季度和第一个季度的接触天数相似（4[2,15]对4[3,7]，P = 0.22）。
尽管大多数mCRPC患者入住了临终关怀机构，但由于住院护理水平较高，他们在生命的最后三个月与医疗保健的接触有所增加。未来的研究可以进一步设定对晚期mCRPC时间毒性的预期。
