The role of integrating palliative care with systemic anticancer treatment at end-of-life: A single center experience.
Authors: Tanin Tiyanont, Nintita Sripaibookij Thokanit, Vijj Kasemsup, Ekaphop Sirachainan, Siriporn Semsarn, Phichai Chansriwong
Journal: Journal of Clinical Oncology (2024)

e24067 Background: This study examines the utilization of systemic anticancer treatments, including chemotherapy, targeted therapy, and immunotherapy, in advanced cancer patients. Specifically, it aims to underscore the impact of integrating palliative care in the administration of anticancer treatment during the last months of life. Methods: A retrospective chart review of patients who received chemotherapy, targeted therapy, and immunotherapy at Ramathibodi Hospital and passed away between January 1, 2019, and December 31, 2022. Demographic data, cancer type, modality, intent, and route of anticancer therapy, as well as health scheme and referral to palliative care services, were collected. Information regarding systemic anticancer treatments administered at 2 weeks, 1 month, 3 months, and 6 months preceding death underwent thorough analysis. Logistic regression was employed to assess odds ratios (OR) and 95% CIs for factors influencing decision-making regarding anticancer treatments. Results: Among the 542 deceased patients, 378 had received anticancer treatments within the last 6 months of life. The distribution of anticancer treatments categorized by timing—6 months, 3 months, 1 month, and 2 weeks before death—was 378 (69.7%), 388 (71.6%), 206 (38.0%), and 129 (23.8%), respectively. Older adults constituted nearly half of the population (45.2%). The utilization of anticancer treatments, particularly in the realms of targeted therapy and immunotherapy, at the terminal stages of life is showing a discernible upward trend. Palliative care consultations were present in 26.9% of cases during cancer care. The presence of palliative care consultation was significantly associated with lower odds ratios of receiving end-of-life anticancer treatments at 2 weeks and 1 month before death (OR: 0.55 [95% CI: 0.33 to 0.89], p = 0.016 and 0.54 [95% CI: 0.36 to 0.85], p = 0.004, respectively). Specifically, integrating palliative care reduced the use of chemotherapy in treatment at 2 weeks and 1 month before death (OR: 0.51 [95% CI: 0.27 to 0.98], p = 0.042 and OR: 0.55 [95% CI: 0.33 to 0.90], p = 0.019, respectively). However, the data showed a decrease in the number of patients; nonetheless, no statistically significant differences were observed in the utilization of targeted therapy and immunotherapy. In our analysis, we examine the factors influencing the utilization of anticancer treatments, reveal that there were no significant differences observed among other factors, including age, cancer type, and health scheme. Conclusions: Integration of palliative care into oncology services significantly correlated with a reduced risk of receiving anticancer treatments, particularly chemotherapy, within the last 30 days of life for advanced cancer patients. Insufficient evidence exists to ascertain the impact of palliative care on the utilization of targeted therapy and immunotherapy.