Palliative care outpatient interventions to limit aggressive care at end-of-life for patients with advanced soft tissue sarcomas.

Abstract

Purpose: Factors reducing aggressive care at the end of life (EOL) for soft tissue sarcoma (STS) are unknown. We aim to evaluate the association between outpatient palliative care (PC) interventions and aggressive care at EOL for STS patients.

Methods: All deceased STS patients in our center were included retrospectively over two years. The exposure was outpatient PC, while outcomes included anticancer therapy administration, emergency room visits, intensive care unit stays, hospital and hospice admissions at EOL.

Results: Among the 83 patients with STS included, most patients were female (58%), with median age [SD] of 65 [15] years, and had a locally advanced/metastatic disease (n = 55, 66%) encompassing leiomyosarcoma (n = 20, 24%) and liposarcoma (n = 17, 21%). Median PC follow-up was 3.5 months (IQR, 1.3-7.6 months). Median aggressive care [range] was 1 [0-4] criteria. Timing and occurrence of outpatient PC interventions were not correlated with EOL care aggressiveness. Univariate analysis showed that outpatient PC interventions were associated with lower rates of anticancer drug use (p = 0.001 and p = 0.02 for the last 30 and 15 days of life, respectively), emergency room visits (p = 0.003), and hospital admissions (p = 0.002) in EOL. In multivariable models, outpatient PC was associated with all aggressive care criteria, excluding admission to hospice. Day hospital was the only independent predictor significantly associated with reduced occurrence of aggressive care (p = 0.002), particularly hospital admissions (p = 0.004).

Conclusion: Outpatient PC, especially day hospitals, could reduce aggressive care at EOL among STS patients. Large-scale studies are needed.