Serum Albumin as a Signal for Near-end-of-life Chemotherapy and Care in Advanced or Recurrent Gastric Cancer

Chemotherapy administered near death is a recognized quality indicator of end-of-life cancer care intensity. However, simple clinical signals to prompt treatment reassessment and coordinate planned end-of-life care remain unclear in advanced gastric cancer. This study evaluated the interval from last chemotherapy to death and explored factors associated with near-end-of-life chemotherapy and failure to transition to a planned end-of-life care setting.

This single-center retrospective study included 53 patients with advanced or recurrent gastric cancer who had complete data regarding final chemotherapy, mortality, and concurrent laboratory findings. The primary endpoint was chemotherapy administration within 30 days of death. A planned end-of-life care setting was defined as a scheduled transition to a palliative care unit, institutional care, or home-based care with visiting nursing support.

The median interval from last chemotherapy to death was 67 days, with 15 patients (28.3%) receiving chemotherapy within 30 days of death. Serum albumin at final chemotherapy was significantly lower in these patients compared to those treated >30 days before death (2.5 vs. 3.2 g/dl, p<0.001), with an optimal cutoff of 2.9 g/dl. Patients receiving chemotherapy ≤30 days before death were less likely to transition to a planned end-of-life care setting (60.0% vs. 91.4%, p=0.015) and more likely to experience emergency hospitalization or sudden clinical deterioration (46.7% vs. 11.4%, p=0.010). Furthermore, albumin ≤2.9 g/dl and C-reactive protein (CRP) >1.0 mg/dl were associated with failure to transition to a planned care setting.

Low serum albumin at final chemotherapy may serve as a practical clinical trigger for reassessing treatment continuation and facilitating timely end-of-life care planning in advanced or recurrent gastric cancer.