Abstract
Background:
Immune checkpoint inhibitors (ICIs) have revolutionized treatment for many patients with advanced cancer. Little is known about ICI use near the end of life.
Objective:
To describe ICI use near the end of life.
Design:
Retrospective study of patients who received ICIs and died.
Setting/Subjects:
Patients treated with ICIs who died between August 2014 and December 2018 (N = 441) at the University of Iowa.
Measurements:
Comparisons were made between patients who received ICIs ≤30 days versus patients who received ICIs >30 days before death. The same analysis was done using a cutoff of 90 days.
Results:
Two hundred ninety-four (67%) patients received ICIs in the last 90 days of life and 117 (27%) patients received ICIs in the last 30 days of life. Patients who received ICIs in the last 30 days of life received fewer mean doses and more often ≤3 total doses. They also had higher mean Eastern Cooperative Oncology Group (ECOG) scores, more patients with ECOG ≥3, higher rates of dying in the hospital, and lower hospice enrollment. Patients treated with ICIs in the last 90 days of life received fewer doses, more often ≤3 total doses, had a higher mean ECOG score, more patients with ECOG ≥3, and lower hospice enrollment. $7.1 million USD was spent on ICI medications in the last 90 days of life.
Conclusion:
ICI use near the end of life is associated with poor performance status, lower hospice enrollment, dying in the hospital, financial toxicity, and minimal clinical benefit.
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