End-of-Life Care for Patients With Metastatic Renal Cell Carcinoma in the Era of Oral Anticancer Therapy
Year: 2022
Type: article
Study design: Observational Study
Abstract: PURPOSE: New therapies including oral anticancer agents (OAAs) have improved outcomes for patients with metastatic renal cell carcinoma (mRCC). However, little is known about the quality of end-of-life (EOL) care and systemic therapy use at EOL in patients receiving OAAs or with mRCC. METHODS: We retrospectively analyzed EOL care for decedents with mRCC in two parallel cohorts: (1) patients (RCC diagnosed 2004-2015) from the University of North Carolina's Cancer Information and Population Health Resource (CIPHR) and (2) patients (diagnosed 2007-2015) from SEER-Medicare. We assessed hospice use in the last 30 days of life and existing measures of poor-quality EOL care: systemic therapy, hospital admission, intensive care unit admission, and > 1 ED visit in the last 30 days of life; hospice initiation in the last 3 days of life; and in-hospital death. Associations between OAA use, patient and provider characteristics, and EOL care were examined using multivariable logistic regression. RESULTS: We identified 410 decedents in the CIPHR cohort (53.4% received OAA) and 1,508 in SEER-Medicare (43.5% received OAA). Prior OAA use was associated with increased systemic therapy in the last 30 days of life in both cohorts (CIPHR: 26.5% v 11.0%; P < .001; SEER-Medicare: 23.4% v 11.7%; P < .001), increased in-hospital death in CIPHR, and increased hospice in the last 30 days in SEER-Medicare. Older patients were less likely to receive systemic therapy or be admitted in the last 30 days or die in hospital. CONCLUSION: Patients with mRCC who received OAAs and younger patients experienced more aggressive EOL care, suggesting opportunities to optimize high-quality EOL care in these groups.
Source: JCO Oncology Practice
DOI: 10.1200/op.22.00401
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: American Association for Cancer Research, Bristol-Myers Squibb, Eli Lilly and Company, Pfizer, AstraZeneca, Sanofi, California Department of Public Health, University of Southern California, American Society of Clinical Oncology, iRhythm Technologies, Genomic Health, Boston Scientific Corporation, Regeneron Pharmaceuticals, Exelixis, Acceleron, Constellation Pharmaceuticals, Mirati Therapeutics, Calithera Biosciences, Eisai, Astellas Pharma, Ono Pharmaceutical, Aptitude Health, National Institutes of Health, Centers for Disease Control and Prevention, Genentech, EMD Serono, National Cancer Institute, National Center for Chronic Disease Prevention and Health Promotion, National Center for Advancing Translational Sciences
Awards: G1032411263, G1044130170, G1289825209, G1393855433, G2238803135, G2612351997, G2639781304, G3014186981, G3161224617, G3190882026, G3509688676, Disparities in the Use of Oral Anticancer Agents in Kidney Cancer, North Carolina Translational & Clinical Sciences Institute (NC TraCS), G4203349661, G4322373146, G4393609197, G480705112, G5333917095, G5433357946, G5570217171, G6795547015, G793654858, G8923144227, Yale Clinical and Translational Science Award
OpenAlex ID: W4309636087