Cohn Julia G, Locke Susan C, Herring Kris W, Dent Susan F, LeBlanc Thomas W
Duke University School of Medicine, Durham, NC, USA.
Duke Cancer Institute, Durham, NC, USA.
Breast Cancer Res Treat. 2025 Aug 16. doi: 10.1007/s10549-025-07805-4.
Metastatic breast cancer (MBC) is incurable, despite therapeutic advances, especially in hormone receptor positive (HR+) and human epidermal growth factor-2 negative (HER2-) disease. Specialist palliative care (SPC) is recommended to alleviate distress and reduce overly aggressive end-of-life (EoL) care. This study determined rates of SPC, hospice utilization, and aggressive EoL care in patients with HR+/HER2- MBC.
A retrospective review was performed of patients with treatment naïve HR+/HER2- MBC treated with endocrine therapy and/or cyclin-dependent kinase 4 and 6 inhibitors at Duke Cancer Institute between January 2012 and December 2017. Variables pertaining to SPC and hospice use and EoL care outcomes up to March 2024 were collected. SPC and hospice utilization and EoL care data were analyzed with descriptive statistics.
Of 102 patients, 85 died during the study period, and over half (55%) received aggressive EoL care. Half had some form of SPC, and rates of aggressive EoL care were comparable between those who engaged with SPC and those who did not. The most common indicators of aggressive EoL care included multiple ED visits (28%) and hospital admissions (23%) in the last 30 days of life as well as in-hospital location of death (24%). Although 72% enrolled in hospice care, 9% of patients were on hospice for ≤ 3 days.
This real-world study demonstrates that many patients with HR + /HER2- MBC receive aggressive EoL care despite some engaging with SPC and many enrolling in hospice. Interventions to decrease aggressive EoL care are needed for this population.
尽管治疗取得了进展，但转移性乳腺癌（MBC）仍无法治愈，尤其是在激素受体阳性（HR+）和人表皮生长因子2阴性（HER2-）的疾病中。建议采用专科姑息治疗（SPC）来缓解痛苦并减少过度积极的临终（EoL）护理。本研究确定了HR+/HER2-MBC患者的SPC使用率、临终关怀机构的使用情况以及积极的EoL护理情况。
对2012年1月至2017年12月在杜克癌症研究所接受内分泌治疗和/或细胞周期蛋白依赖性激酶4和6抑制剂治疗的初治HR+/HER2-MBC患者进行了回顾性研究。收集了截至2024年3月与SPC、临终关怀机构使用情况以及EoL护理结果相关的变量。采用描述性统计分析SPC、临终关怀机构的使用情况以及EoL护理数据。
在102例患者中，85例在研究期间死亡，超过一半（55%）接受了积极的EoL护理。一半患者接受了某种形式的SPC，接受SPC的患者和未接受SPC的患者之间积极的EoL护理发生率相当。积极的EoL护理最常见的指标包括在生命的最后30天内多次急诊就诊（28%）和住院（23%）以及在医院内死亡（24%）。尽管72%的患者登记接受临终关怀，但9%的患者接受临终关怀的时间≤3天。
这项真实世界研究表明，许多HR+/HER2-MBC患者尽管部分患者接受了SPC且许多患者登记接受了临终关怀，但仍接受了积极的EoL护理。该人群需要采取干预措施以减少积极的EoL护理。
