Systemic anticancer therapy at the end of life: real-world insights from a tertiary oncology center in Israel

Abstract

Background: Aggressive end-of-life (EOL) care, such as systemic anticancer therapy (SACT) for advanced cancer patients, represents a potential indicator of low-quality care that may deviate from the primary palliative objective of treatment.

Methods: A retrospective study analyzed consecutive patients with advanced cancers treated at a tertiary oncology center in Israel from January 2019 to December 2022. Demographic and clinical data were examined, with a focus on intravenous (IV) oncologic treatment administration rates at 30 and 90 days before death.

Results: The study included 1851 patients who received IV oncologic medications and died during 2019-2022. The median age at death was 69 years, with 51.3% (951) being men. Systemic anticancer therapy administration rates were 36% (666 patients) in the last 30 days and 67.6% (1252 patients) in the last 90 days prior to death. Chemotherapy was the most common EOL medication (58%). Higher EOL SACT rates were associated with younger age, better ECOG performance status, shorter disease duration, and specific tumor origins, particularly breast cancer. Conversely, gender, marital status, and ethnicity showed no significant correlation with EOL treatment use.

Discussion: Our data provide insight into current practice adopted by healthcare professionals regarding EOL treatment administration in Israel. A positive EOL experience is a significant goal in the oncology clinic, yet our findings demonstrate high rates of aggressive EOL care and may highlight the necessity for regulatory and educational changes within the healthcare system.

Keywords: aggressive care; end of life; good death; palliative care; systemic anticancer therapy.

Figure 1.

Rate of systemic anticancer therapy administration in last 30 and 90 days of life, by year.

Figure 2.

Rate of first-line therapy initiation at last 30 days and last 90 days of life, by year (A), rate of initiation of subsequent line of treatment at the last 30 and 90 days of life, by year (B).