30-day mortality associated with systemic anti-cancer therapy (SACT) in gastrointestinal malignancies: The Christie experience
Authors: F. Marti Marti, A. McGurk, N. Alam, L. Bhatt, M. Braun, R. Hubner, W. Mansoor, C. McBain, M. McNamara, S. Mullamitha, M. Saunders, H. Sheikh, F. Thistlethwaite, J. Valle, G. Wilson, J. Hasan
Journal: Annals of Oncology (2018)

Introduction: Although SACT has very well-known associated toxicities, the safe delivery of it is of paramount importance in current oncology practice. The systematic and prospective analysis of deaths occurring within 30 days of SACT administration provides an optimal opportunity to identify trends, appraise current practice and improve patient care. Here, we present the data from our cancer centre. Methods: GI cancer patients constitute 20% of the caseload at The Christie NHSFT which sees on average 8000 new patients and delivers 60000 chemotherapy episodes yearly. A prospective database to record and analyse deaths occurring within 30 days of SACT was established in September 2009. This database recorded the deaths registered within the GI oncology group, which included Upper GI (Gastro-oesophageal and Hepatobiliary) and Lower GI malignancies. The database included basic demographics for each individual patient and recorded details of the chemotherapy regimen, dosing, etc. The treatment intent was recorded for each case. As part of the exercise, deaths were discussed within the group where causality of the death in relation to SACT treatment was allocated. The four causality categories were: definitely treatment related, probably treatment related, possibly treatment related and non-treatment related. Any suggested improvements and recommendations for future practice were also annotated. The data reported here are for the period between September 2009 and February 2017. Results: 469 deaths within 30 days of SACT were recorded during this period. Of those, 258 (55%) patients had been treated for a lower GI and 211 (45%) for an upper GI cancer. Average age at death was 65 years (18- 88). 307 of the reported deaths (65%) were in male patients. The number of chemotherapy cycles delivered prior to death ranged from 1 to 33. About one third of deaths (n = 149; 31.8%) occurred after the first cycle of chemotherapy. Overall, 245 (52%) deaths occurred within the first two cycles of chemotherapy. In terms of causality, 21 (4.4%) deaths were felt to be definitely related to SACT; 28 (6%) probably related; 88 (18.7%) possibly related and 332 (70.7%) non-related to SACT administration. Of those deaths definitely related to SACT, 8 (38%) were caused by neutropenic sepsis. Disease progression accounted for 248 (75%) of the deaths felt not to be related to SACT. When split by treatment intent, 12 deaths (2.5%) were reported in patients having adjuvant chemotherapy and 8 (1.7%) in the neo-adjuvant group. 7 deaths occurred in patients having radical treatment (1.5%). The rest of the deaths occurred in patients with metastatic disease (n = 442; 94%). Conclusion: The systematic report and analysis of deaths within 30 days of SACT delivery in our institution provided a well-structured platform to identify specific patterns of occurrence. The early stages of chemotherapy delivery emerged as a crucial period. Increased monitoring of toxicity during the early phases of SACT delivery might lead to reduced mortality. Further understanding of the patients that die as a consequence of SACT might help identify those at risk and lead to a change in follow-up protocols and/or upfront dosage. Mature data will be presented at the meeting.