Novel Systemic Anticancer Therapy and Healthcare Utilization at the End of Life: A Retrospective Cohort Study

Novel systemic anticancer therapies (SACT) in the form of targeted and immunotherapies are increasingly replacing traditional chemotherapy. Little is known about the impact of novel SACT on healthcare resource utilization (HCRU) at the end of life.

A retrospective review of patients attending a tertiary cancer center in Toronto, Canada, with advanced solid or hematological malignancies who died in 2019. Demographic and cancer data, SACT use, HCRU (emergency room [ER] visits, acute/intensive care unit [ICU] admission, and place of death) were retrieved and compared between those who received SACT in their last 30 days of life and those who did not. Chi-squared tests or Quasi-Poisson regression calculated HCRU expressed as percentages or rate ratios (RR). Univariate and multivariable logistic regression identified factors independently associated with SACT use.

Of 443 patients included, 88 (20%) received SACT in the last 30 days of life, with 42 (48%) receiving targeted therapies and 10 (11%) immunotherapy. Factors associated with SACT use included younger age (p = 0.016), breast (p < 0.001), lung (p = 0.047), hematological malignancies (p = 0.002), fewer comorbidities (p = 0.039), and novel SACT (p = 0.006). Receipt of SACT was associated with a higher frequency of ER visits (55% vs. 36% who did not receive SACT, p = 0.001), acute hospitalizations (68% vs. 47%, p < 0.001), ICU admissions (18% vs. 7%, p = 0.003), and death in hospital (45% vs. 30%, p = 0.008).

Novel SACT use at the end of life is high and is strongly associated with HCRU. Future studies should explore the impact of advance care planning and palliative care referrals on SACT use.