TY - JOUR
T1 - End-of-Life Care for Patients with Metastatic Renal Cell Carcinoma in the Era of Oral Anticancer Therapy
AU - Dzimitrowicz, Hannah E.
AU - Wilson, Lauren E.
AU - Jackson, Bradford E.
AU - Spees, Lisa P.
AU - Baggett, Christopher D.
AU - Greiner, Melissa A.
AU - Kaye, Deborah R.
AU - Zhang, Tian
AU - George, Daniel
AU - Scales, Charles D.
AU - Pritchard, Jessica E.
AU - Leapman, Michael S.
AU - Gross, Cary P.
AU - Dinan, Michaela A.
AU - Wheeler, Stephanie B.
N1 - Publisher Copyright:
© American Society of Clinical Oncology.
PY - 2023/2/1
Y1 - 2023/2/1
N2 - 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.
AB - 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.
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U2 - 10.1200/OP.22.00401
DO - 10.1200/OP.22.00401
M3 - Article
C2 - 36413741
AN - SCOPUS:85147895390
SN - 2688-1527
VL - 19
SP - E213-E227
JO - JCO Oncology Practice
JF - JCO Oncology Practice
IS - 2
ER -