Chemotherapy at the end of life in colorectal and pancreatic cancer: Real-world data and trends over time.

Authors

null

Catherine Dunn

Walter and Eliza Institute of Medical Research, Melbourne, VIC, Australia

Catherine Dunn , Belinda Lee , Jeremy David Shapiro , Rachel Wong , Grace Gard , Michael Michael , Wei Hong , Matthew E. Burge , Vanessa Wong , Ben Thomson , Sumitra Ananda , Sue-Anne McLachlan , Brett Knowles , Mehdrad Nikfarjam , Jeanne Tie , Ross Jennens , Joseph James McKendrick , Margaret Lee , Suzanne Kosmider , Peter Gibbs

Organizations

Walter and Eliza Institute of Medical Research, Melbourne, VIC, Australia, Northern Health, Peter MacCallum Cancer Centre, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia, Cabrini Health, Malvern, VIC, Australia, Eastern Health, Walter and Eliza Hall Institute of Medical Research, Epworth Health and University of Melbourne, Melbourne, Australia, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia, Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia, Walter & Eliza Hall Institute of Medical Research, Melbourne, Australia, Royal Brisbane and Women's Hospital, Brisbane, Australia, Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia, Royal Melbourne Hospital, Melbourne, Australia, Walter and Eliza Hall Institute of Medical Research, Peter MacCallum Cancer Centre and Western Health, Melbourne, Australia, Medical Oncology, St Vincent's Hospital and Department of Medicine, Melbourne University, Melbourne, Australia, Peter Maccallum Cancer Centre, Parkville, VIC, Australia, Austin Health, Melbourne, Australia, Peter MacCallum Cancer Centre, Western Health and Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia, Epworth Hospital, Richmond, VIC, Australia, Eastern Health, Melbourne, Australia, Eastern Health, Western Health, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia, Western Health, Melbourne, Australia, The Walter and Eliza Hall Institute of Medical Research & Western Health, Melbourne, Australia

Research Funding

No funding received
None

Background: Chemotherapy at the end of life (CEOL) is widely accepted as an indicator of aggressive care. However, the evidence is limited primarily to single-centre experiences, with no consensus regarding acceptable benchmarks for CEOL, nor how this may be changing over time and with novel treatment options. We describe ‘real world’ CEOL in two large, multisite Australian registries of metastatic colorectal cancer (mCRC) and both locally advanced and metastatic pancreatic cancer (PC). Methods: Data was analysed from the TRACC and PURPLE registries, two large prospective multisite Australian cancer registries collecting prospective demographic, tumour, treatment and outcome data for mCRC and PC respectively. We identified all decedents between May 2009 and November 2020, determined the proportion who died within 14 or 30 days of chemotherapy (14D / 30D), or within 30D after a new line of therapy, defined as the first cycle of a new treatment regimen. Using univariate analysis, we compared baseline demographic and clinicopathological variables and trends over time. Results: 1505 mCRC and 602 PC decedents were identified. 20.9% of decedents (21.6% mCRC and 19.3% PC) received chemotherapy within 30D, and 11.5% within 14D (12.3% mCRC and 9.6% PC). There were lower rates of 30D CEOL after the first cycle of a new line of therapy (4.3% mCRC and 5.7% PC). Rates of CEOL decreased over the study period for mCRC (median rate of initial 3-year period 28% versus 15% in last 3-year period), but remained largely static for PC (18.9% versus 17.9%). 30D CEOL was more likely with palliative than curative intent treatment (mCRC OR 1.6, 95% CI 1.14-2.25, p = 0.007, PC OR 5.3, 95% CI 1.6-17.8), and advanced rather than local disease in PC (PC OR 2.59, 95%CI 1.6-4.1, p < 0.001). There was a trend towards CEOL and poorer performance status (ECOG) across all groups, only significant for 30D CEOL mCRC (OR 1.51, 95% CI 1.04-2.2). There was no association between CEOL and patient age, gender, Charlson comorbidity score or lines of therapy. Conclusions: Real-world rates of CEOL are higher in our cohorts of mCRC and PC patients than historical benchmarks but comparable to contemporary reports, which may be due to a wider array of available active treatments. Overall rates are decreasing over time for mCRC but static for PC, which may reflect the poorer overall survival for PC and lack of new effective therapies. The lower rates of death after new lines of therapy may signify that CEOL is more likely with existing treatment regimens and that clinicians are less likely to initiate a new chemotherapeutic regimen at EOL.

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Health Services Research and Quality Improvement

Track

Quality Care/Health Services Research

Sub Track

Real-World Data/Outcomes

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr e18723)

DOI

10.1200/JCO.2021.39.15_suppl.e18723

Abstract #

e18723

Abstract Disclosures