Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2018

Are we overtreating Queensland cancer patients near end-of-life? (#391)

Michael J Allen 1 2 , Nathan Dunn 3 , Tracey Guan 3 , John Harrington 3 , Nancy Tran 3 , Euan Walpole 1 2 4 , Neal Rawson 5
  1. The Princess Alexandra Hospital, Queensland Health, Brisbane, Queensland, Australia
  2. School of Medicine, University of Queensland, Brisbane, Queensland, Australia
  3. Queensland Cancer Control Analysis Team, Cancer Alliance Queensland, Brisbane, Queensland, Australia
  4. Queensland Cancer Control Safety and Quality Partnership, Queensland Health, Brisbane, Queensland, Australia
  5. Queensland Cancer Control Analysis Team, Queensland Health, Brisbane, QLD, Australia

Aim

To assess the patterns of treatment near end-of-life (EOL) for Queensland lung and pancreatic cancer patients.  For patients receiving IV systemic therapy (IVST), we calculated the proportion receiving IVST near EOL and the proportion of patient deaths occurring in an acute care setting.

Methods

Data was obtained from the Queensland Oncology Repository and the study population was selected from those Queensland cancer patients diagnosed with lung (n=20,768) or pancreatic (n=4,759) cancer between 2005-2014. From this population, the focus was on patients receiving IVST (lung: 8,237; pancreas: 1,951). EOL IVST was assessed as being within 30 days of death.  IVST should only be administered to lung and pancreatic patients if they have good performance status (PS). As PS predicts survival, evidence suggests IVST should not be administered in the last 30 days of life. Location of death was reported as being in acute hospital setting or other (subacute, palliative, community care).

Results

Approximately 40% of all lung and pancreatic cancer patients in this study received IVST during treatment.  Among lung cancer patients receiving IVST, 20% received EOL IVST; for pancreatic cancer 26%.

Nil difference in EOL IVST administration was noted across age, sex, socio-economic status, Indigenous status or public/private facility for lung cancer patients. Among pancreatic cancer patients, nil difference was observed apart from males (29%) being more likely than females (21%) to receive IVST within last 30 days of life (p<0.001).

Death in an acute care setting was more likely if EOL IVST was administered for both lung (50%) and pancreatic (46%) patients when compared to all patient deaths (acute care deaths: lung-31%; pancreatic-29%).

Discussion

EOL treatment rates for Queensland lung and pancreatic cancer patients are comparable to those reported nationally and internationally, with increased rates among male cancer patients also noted elsewhere.