Abstract
Background
Systemic anticancer therapy (SAT) near the end of life is an indicator of potentially aggressive cancer care. Although patient-level prognostic factors have been studied, the role of treatment escalation within hospital-centered oncology models remains insufficiently understood. This study evaluated late-stage SAT and its determinants.
Methods
A retrospective cohort of 118 patients with metastatic solid tumors who died between March 25, 2020, and April 30, 2025, was analyzed. Receipt of SAT within the last 30 and 14 days of life was assessed. Multivariable logistic regression identified factors independently associated with SAT in the final 30 days. Indicators of end-of-life care intensity were examined.
Results
SAT was administered to 42.4% of patients within the last 30 days of life and to 13.6% within the last 14 days. A new systemic treatment line was initiated within the final 2 months of life in 44.1% of patients. Recent treatment escalation was independently associated with therapy use in the last 30 days (adjusted OR 4.21, 95% CI, 1.89–9.38; P < .001), whereas age, performance status, and prior treatment burden were not significant predictors. Median survival from last treatment to death was 40 days. Overall, 73.7% of patients died in the hospital, and 50% in the intensive care unit (ICU).
Conclusions
Recent treatment escalation was the main determinant of exposure to late-stage SAT. High hospitalization and ICU death rates suggest end-of-life care was delivered within a hospital-centered model. Earlier integration of palliative care and structured prognostic communication may better align treatment decisions with patient-centered goals.
Keywords
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