Abstract P2-01-13: Palliative Care Use and End-of-Life Care Quality in HR+/HER2- Metastatic Breast Cancer

Abstract                Background: Metastatic breast cancer (MBC) is incurable, but therapeutic advances have improved clinical outcomes for patients with hormone receptor positive (HR+), human epidermal growth factor-2 negative (HER2-) disease. Palliative care (PC) is recommended to alleviate distress of patients with advanced cancer and reduce administration of aggressive care at the end of life. Intensive end-of-life (EoL) care is associated with greater physical and emotional distress of patients and caregivers. Despite current guidelines, there is limited data in prior literature on PC use and EoL care of patients with MBC benefitting from therapies such as cyclin-dependent kinase 4/6 inhibitors (CDK4/6i). The aim of this study is to describe referral to PC, hospice utilization, and EoL outcomes, including rate of aggressive EoL care, in patients with HR+/HER2- MBC. Methods: A secondary analysis of data from a retrospective review of patients with HR+/HER2- MBC treated with endocrine therapy +/- CDK4/6i for first-line MBC at the Duke Cancer Institute between 1/2012 and 12/2017 was performed. Data extracted from the electronic medical record included demographic and clinical characteristics at MBC diagnosis. Variables added for this analysis and abstracted through 3/15/24 included PC involvement, hospice use and duration of care, and EoL care outcomes, including place of death, healthcare utilization in last 30 days of life, and chemotherapy in last 30 and 14 days of life. PC and hospice utilization and EoL care data were analyzed with descriptive statistics. Results: Of 102 patients in the cohort, 85 died during the study period, 77 of whom had complete EoL care data. Mean age at metastatic diagnosis was 61.9 (SD 12.1; range 27-84 yrs) and mean age at death was 66.0 (11.9; 33-86 yrs). Over half (n=42/77, 55%) received aggressive EoL care. Half of the cohort received some form of PC (51/102, 50%). Among the deceased, rates of aggressive EoL care were comparable between those who engaged with PC (24/45, 53%) and those who did not (18/32, 56%). Of those who received PC, in-hospital referrals were more common (31/51, 61%) than ambulatory referrals (19/51, 37%). Similar proportions engaged with PC in outpatient clinics (28/51, 55%) as those with exclusively inpatient PC encounters (23/51, 45%). Median number of outpatient PC visits was 2 (range 1 – 16 visits among deceased). Among the indicators of aggressive EoL care, multiple emergency department (ED) visits (22/79, 28%) and hospital admissions (18/79, 23%) in the last 30 days of life as well as in-hospital location of death (20/85, 24%) were the most common. Chemotherapy was administered within the last 30 days for 16 patients (16/80, 20%) and within the last 14 days of life for 9 patients (9/80, 11%). Among the 72% (61/85) who enrolled in hospice, 9% (7/82) were on hospice care for ≤ 3 days. Of the 15 patients who received hospice care for more than 3 days and received aggressive EoL care, most had multiple ED visits (n=11) and/or hospital admissions (n=7) in the last 30 days of life. Conclusion: This real-world study demonstrates that patients with HR+/HER2- MBC receive aggressive care at EoL despite some engaging with PC and many enrolling in hospice care. PC involvement did not appear to impact receipt of aggressive EoL care. This may be a result of the low median number of outpatient PC visits, representing insufficient PC “dosage” to facilitate complex symptom management and advance care planning required to reduce aggressive EoL care. Interventions to enhance PC engagement and decrease aggressive EoL care are needed to reduce in-hospital deaths, frequency of ED visits, hospitalizations, and intensive care unit admissions in the last month of life, and to ensure patients with MBC experience hospice services for a sufficient duration to derive meaningful benefit.                Citation Format: Julia Cohn, Susan C. Locke, Kris W. Herring, Susan F. Dent, Thomas W. LeBlanc. Palliative Care Use and End-of-Life Care Quality in HR+/HER2- Metastatic Breast Cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P2-01-13.