The Influence of Specialist Palliative Care in Aggressive End of Life Management of Patients with Advanced Cancer.

Introduction: There is a growing concern that terminally ill cancer patients may be receiving aggressive management at the end of life. This study aimed to evaluate the use of aggressive management (anticancer treatment and medical care) in patients with advanced cancer in their last month of life and to evaluate the influence of specialist palliative care on it.

Methods: This retrospective study included adult patients with advanced solid cancers treated at the Institute of Oncology Ljubljana who died between January 2015 and December 2019. Multiple logistic regression models were used to assess the association between the aggressiveness of anticancer treatment and medical care, the year of death, age at death, sex, prognosis, type of cancer and inclusion of specialist palliative care.

Results: We included 1,736 patients in our analysis. 538 (31%) patients received at least one anticancer treatment modality. There was an increasing use of chemotherapy and novel systemic therapies. A significant predictor for aggressive anticancer treatment (OR 0.96; 95% CI 0.95-0.97) and medical care (OR 0.96; 95% CI 0.95-0.97) was younger age. Inclusion into the specialist palliative care was strongly associated with less aggressive anticancer treatment (OR 0.19; 95% CI 0.12-0.31) and medical care (OR 0.25; 95% CI 0.15-0.40).

Conclusions: In the last month of life, there was an increasing use of chemotherapy and novel systemic therapies, especially in younger patients. Inclusion in specialist palliative care was associated with less aggressive end-of-life management.