Minimisation of aggressive medical interventions at the end of life and rational de-prescribing of anti-cancer treatment are goals of supportive care. Using a cohort of men with metastatic prostate cancer (mPCa), we analysed decision-making concerning the withdrawal of anti-cancer endocrine therapies during the provision of terminal care.
We performed a retrospective audit of patients who received endocrine therapies and died of mPCa at Eastern Health, Melbourne, from 2014-2018. Patient records provided clinicopathologic and treatment data, which were analysed using descriptive statistics.
A total of 100 men with mPCa and documentation of prior endocrine therapy were admitted for terminal care under the palliative care or oncology teams. Median age at death was 79 years (range 55-101); median interval from detection of metastatic disease to death was 25 months (range 0-105). Median length of stay was 9 days (range 0-60).
In the large majority of patients, the last use or cessation of standard-of-care depot endocrine therapy was not documented in the inpatient notes. Of the 33 patients recorded as receiving single or dual-agent endocrine therapy, 26 had documented discussions to cease treatment. Of these, 22 had general end-of-life care discussions and four had discussions specific to their endocrine therapy. For patients receiving oral endocrine therapy, median time from cessation of therapy to death was 2 days (range 1-31 days).
Even within specialty inpatient units, patients may continue anti-cancer treatments within days of death. The majority of patients did not have a discussion specific to ceasing their endocrine therapy. The value of endocrine treatments in the terminal phase of care is unknown. Decisions around cessation of anti-cancer treatments for people with terminal phase cancer may be improved by the development of consensus guidelines around stopping non-chemotherapy medications.