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. 2022 Mar 5;22(1):247.
doi: 10.1186/s12885-022-09316-7.

Anti-tumor treatment and healthcare consumption near death in the era of novel treatment options for patients with melanoma brain metastases

Annemarie C Eggen  1   2 , Geke A P Hospers  1 , Ingeborg Bosma  3 , Miranda C A Kramer  4 , Anna K L Reyners  1   2 , Mathilde Jalving  5
Affiliations

Anti-tumor treatment and healthcare consumption near death in the era of novel treatment options for patients with melanoma brain metastases

Annemarie C Eggen et al. BMC Cancer. .

Abstract

Background: Effective systemic treatments have revolutionized the management of patients with metastatic melanoma, including those with brain metastases. The extent to which these treatments influence disease trajectories close to death is unknown. Therefore, this study aimed to gain insight into provided treatments and healthcare consumption during the last 3 months of life in patients with melanoma brain metastases.

Methods: Retrospective, single-center study, including consecutive patients with melanoma brain metastases diagnosed between June-2015 and June-2018, referred to the medical oncologist, and died before November-2019. Patient and tumor characteristics, anti-tumor treatments, healthcare consumption, presence of neurological symptoms, and do-not-resuscitate status were extracted from medical charts.

Results: 100 patients were included. A BRAF-mutation was present in 66 patients. Systemic anti-tumor therapy was given to 72% of patients during the last 3 months of life, 34% in the last month, and 6% in the last week. Patients with a BRAF-mutation more frequently received systemic treatment during the last 3 (85% vs. 47%) and last month (42% vs. 18%) of life than patients without a BRAF-mutation. Furthermore, patients receiving systemic treatment were more likely to visit the emergency room (ER, 75% vs. 36%) and be hospitalized (75% vs. 36%) than those who did not.

Conclusion: The majority of patients with melanoma brain metastases received anti-tumor treatment during the last 3 months of life. ER visits and hospitalizations occurred more often in patients on anti-tumor treatment. Further research is warranted to examine the impact of anti-tumor treatments close to death on symptom burden and care satisfaction.

Keywords: Anti-tumor treatment; End-of-life care; Healthcare consumption; Melanoma; Neuro-oncology.

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Conflict of interest statement

GAPH is a consultant/advisory board member for Amgen, Roche, Merck, Bristol-Myers Squibb, Pfizer, Novartis, and Pierre Fabre, and has received grants from Bristol-Myers Squibb and Seerave, outside the submitted work and paid to the institution. MJ has served as an advisory board member for Bristol-Myers Squibb, Novartis, Merck, and Pierre Fabre, fees paid to the institution. The other authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Swimmer plot of time between metastatic melanoma and death, including treatments received for melanoma brain metastases in last 3 months of life. Patients are stratified by BRAF-mutational status and treatments received prior to the last 3 months of life A: patients with a BRAF-mutation, B: patients without a BRAF-mutation
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