Evaluation of end-of-Life chemotherapy: a medical and economic challenge revealed by a retrospective observational study.

PURPOSE

The continuation or discontinuation of oncological care is a critical consideration, particularly due to its implications for quality of life at the end of life. We evaluated the management of cancer patients during the final 90 days of life by measuring the intensity of care and assessing its overall impact.

METHOD

Characterize care pathways and patient status during the last 90 days of life, including a survival analysis based on Charlson and BARBOT (Pronopall) scores. Care intensity was evaluated using a composite score based on hospitalizations, emergency visits, and ICU admissions. We also compared chemotherapy-treated and untreated patients in terms of survival, care intensity, polypharmacy, and healthcare resource use, focusing on hospitalization and chemotherapy-related costs.

RESULTS

In total, 270 patients with a median age of 69 (23-96) years were included. During the last 90 days of life, most patients (67.8%) had one or no indicators of high-intensity care. Chemotherapy was administered to 195 patients (72.2%), 80 patients (29.6%) were hospitalized more than once, 38 (14.1%) had multiple emergency department visits, and 5 (1.9%) were admitted to intensive care. Patients who received treatment were significantly younger (p = 0.0058) and in better general condition (p = 0.0129). They were more frequently hospitalized (p = 0.0039), and death occurred more often in hospital wards (p = 0.0223). The total cost of care was significantly higher for treated patients.

CONCLUSION

Our findings emphasize the pivotal and potentially detrimental role of chemotherapy administration at the end of life.