Broad-Spectrum Antibiotic Use at the End of Life in Patients With Advanced Cancer

Area of Science:

• Oncology
• Pharmacology
• Public Health

Background:

• Patients with advanced cancer often receive broad-spectrum antibiotics.
• Understanding antibiotic use patterns near end-of-life is crucial but poorly understood.

Purpose of the Study:

• To describe broad-spectrum antibiotic use patterns in advanced cancer patients across defined end-of-life intervals.

Main Methods:

• Nationwide, population-based, retrospective cohort study using South Korean National Health Insurance Service data (2002-2021).
• Examined broad-spectrum antibiotic use (antipseudomonal β-lactams, carbapenems, glycopeptides) in patients with various advanced cancers.
• Analyzed prescription proportion and consumption amount across five end-of-life intervals (T1-T5).

Main Results:

• Over 515,000 decedents were analyzed; 55.9% received broad-spectrum antibiotics in the last 6 months of life.
• Antibiotic prescription proportion peaked 1-3 months before death (T2), while consumption peaked 2 weeks to 1 month before death (T3).
• Leukemia patients showed higher broad-spectrum antibiotic exposure in the final week compared to lung cancer patients.

Conclusions:

• Broad-spectrum antibiotic use escalates in the final months before death in advanced cancer patients.
• This period (3 months to 2 weeks pre-death) represents a key opportunity for optimizing antibiotic stewardship.
• Aligning antibiotic use with patient goals of care is essential during this critical phase.