Background: Aggressive EOL cancer care is a health care quality and cost issue. As lung cancer is the leading cause of cancer-related death in the U.S., and NCCN member institutions are considered to offer high-quality, evidence-based care, we examined the aggressiveness of mNSCLC EOL care at NCCN institutions. Methods: The NCCN database was queried to identify all deceased mNSCLC patients (pts) actively treated at 8 NCCN institutions from January 2007-June 2010. Aggressive EOL care was defined as 1) Starting a new CT regimen within 30 days of death (30d New), 2) Receipt of CT within 14 days of death (14d Any), or 3) Any ICU admission within the last 30 days of life (30d ICU). Among pts receiving CT, multivariate logistic regression was used to investigate associations between pt factors and aggressive CT use, controlling for age, NCCN institution, performance status (PS), and comorbidity. Multivariate analysis was not possible for the ICU model due to small sample size. Results: Among 1,092 eligible pts, 18.9% had 1 or more aggressive EOL events: 10.7% 30d New, 11.8% 14d Any, and 3.2% 30d ICU. Forty (34%) of 30d New pts started first line CT. Median age overall was 63 (range 25-91) and was 61 for all pts in the aggressive CT analyses. Initial overall PS was 57% 0-1 and was still predominantly 0-1 (23-38%) at the last CT in all groups. The multivariate results are listed below; an odds ratio > 1 indicating aggressive care more likely. Conclusions: While typical pt factors, such as age and PS, are used to determine fitness for CT receipt in mNSCLC, our analysis suggests that aggressive EOL CT receipt in mNSCLC at NCCN institutions is associated with other pt or clinical factors.

*No associations seen with other factors, including age, institution, PS, comorbidity, other metastatic sites, clinical trial participation, time from metastatic diagnosis, gender, race, insurance type, histology, or smoking status at diagnosis.