Too much or too little? The trajectory of systemic anti-cancer treatment throughout the last year of life of lung cancer patients in Norway.

Background: The use of systemic anti-cancer treatment (SACT) at the end of life (EOL) is controversial. The evidence and detailed description of the dynamics of its use are deficient, especially after the introduction of targeted therapies and immunotherapy.

Methods: Clinical information about lung cancer patients dying in the years 2020-2023 was extracted from the Cancer Registry of Norway. Available data on intravenous and oral SACT enabled the calculation of the proportion of patients who received SACT each of the 360 days before death.

Results: A total of 8953 patients were eligible for this study. At day 30, 7, and 1 before death, 8.9%, 1.3%, and 0.4% respectively, received SACT. The reduction was mainly caused by reduced use of chemotherapy and immunotherapy closer to death. Independent predictors for receiving SACT at day 30 before death were young age, male sex, small-cell lung cancer, short time from diagnosis to death, and good performance status.

Conclusion: The presented low use of SACT at EOL has been achieved in a population where good survival has been documented. Patients with poor performance status and older age received less SACT than patients with good performance status and younger age.