Abstract P1-08-20: Healthcare use in the last six months of life in advanced breast cancer: An analysis from the Southeast Netherlands Advanced Breast Cancer (SONABRE) registry
Authors: de Boer M , Schmitz RS , Ibragimova KI , van Kleef M , Geurts SM , Tjan-Heijnen VC 
Published: May 2019

In advanced breast cancer (ABC), a growing number of treatment options have become available the past 10 years, increasing overall survival. Healthcare use near the end of life has increased, although specific data for ABC are limited. This study describes healthcare use during the last 6 months of life in patients diagnosed with ABC in Maastricht University Medical Center (MUMC+).

Methods: From our Southeast Netherlands Advanced Breast Cancer (SONABRE) Registry, we selected all patients from MUMC+ who were diagnosed with ABC and who also had passed away between January 1st, 2007 and October 1st, 2017. Patient, disease and treatment characteristics and data regarding health care use in the last period of life defined as ongoing chemotherapy ≤14 days before death, start of a new line of chemotherapy ≤30 days before death, and radiotherapy, hospital admission, surgery, intensive care unit (ICU) admission, mechanical ventilation, cardiopulmonary resuscitation (CPR) ≤ 6 months before death, and cause and place of death were collected by trained registration clerks. Healthcare use was described and univariate analyses were carried out for ongoing chemotherapy ≤14 days or start chemotherapy line ≤30 days before death, admission and death in the hospital using chi square and Fisher's exact test. The SONABRE Registry was approved by the Medical Research Ethics Committee of Maastricht University Medical Center.

Results: Of 203 included patients, chemotherapy was continued ≤ 14 days before death in 21%, and a new line of chemotherapy ≤ 30 days before death was started in 9% of patients. In the last 6 months of life, radiotherapy was applied in 21% of patients. Hospital admission occurred in 76% of patients, because of tumor-related symptoms in 60%, and because of toxicity in 12% of these. Surgery (4%), ICU admission (6%), mechanical ventilation (5%), and CPR (2%) occurred infrequently. Of all patients, 25% died in the hospital; 74% due to progressive disease, 12% due to complications of therapy for ABC and 14% non-breast cancer related. Ongoing chemotherapy ≤14 days before death was associated with age&lt;65 years (p&lt;0.001) and negative hormone receptor (HR) status (p=0.04); start of a new line of chemotherapy ≤30 days before death was associated with age&lt;65 years (p&lt;0.001). Hospital admission was associated with age&lt; 65 years (p=0.008), de novo ABC (p=0.01), negative HR status (p=0.04) and chemotherapy as last line of therapy (p=0.001). Death in the hospital was associated with ongoing chemotherapy ≤14 days (p&lt;0.001) and start of a new line of chemotherapy ≤30 days before death (p&lt;0.001).

Conclusion: During the last 6 months of life, admission due to tumor-related symptoms occurred frequently, whereas ICU admission, mechanical ventilation and CPR occurred rarely. Death in the hospital occurred in a quarter of patients, and more frequently in those receiving chemotherapy shortly before death, which in turn was associated with younger age. Insight in real-life healthcare use may improve shared decision making and advanced care planning for patients with ABC.

Citation Format: de Boer M, Schmitz RS, Ibragimova KI, van Kleef M, Geurts SM, Tjan-Heijnen VC. Healthcare use in the last six months of life in advanced breast cancer: An analysis from the Southeast Netherlands Advanced Breast Cancer (SONABRE) registry [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-20.