Patient characteristics and quality of life in relation to place of death in lung cancer patients treated with immunotherapy.

Abstract

Objectives: Studies show that cancer patients consider place of death (POD) an important factor influencing quality of life (QoL) at the end of life. The objectives of this study were to identify characteristics of real-world non-small cell lung cancer (NSCLC) patients based on POD and investigate how changes in health-related QoL (HRQoL) relate to POD.

Methods: Newly updated data from a prospective single-center Danish cohort (NCT03870464) of patients with NSCLC who initiated immune checkpoint inhibitors (ICI) as monotherapy between April 1, 2018, and April 30, 2021, at the Department of Oncology, Odense University Hospital, were used for analyses. Clinical data were retrieved from electronic patient records. This included POD, which was categorized as home, hospice/palliative care unit, or hospital. HRQoL questionnaires were completed by patients prospectively at baseline and at predefined timepoints during treatment with ICI.

Results: A higher percentage (63.6%) of patients dying at home were male, and a higher percentage dying in a hospice/palliative care unit were female (63%) (p = 0.041). Patients with hospital as POD had a statistically higher Global health status/QoL (GHS/QoL) at baseline (75.0; p = 0.034). Patients with home or hospice/palliative care unit as POD reported improved QoL during treatment with ICI, as opposed to patients with hospital as POD who had unchanged self-assessed QoL scores.

Significance of results: Sex, baseline GHS/QoL, and change in HRQoL during treatment with ICI differed between patients based on POD. The predictive value of this is unknown, suggesting the need for further research on this topic, as it remains clinically relevant.