Intern Med J. 2026 Aug 4. doi: 10.1111/imj.70583. Online ahead of print.
ABSTRACT
BACKGROUND: Systemic anticancer therapy (SACT) near the end of life can contribute to significant patient morbidity and mortality in an already vulnerable population. There are variable rates of SACT use within 30 days of death in Australia, including immunotherapy (IO).
AIMS: To assess the characteristics of medical oncology patients who died within 30 days of SACT and 30 or 90 days of IO and identify factors associated with treatment-related mortality (TRM).
METHODS: Retrospective study of 2948 medical oncology patients at a tertiary metropolitan hospital, between 1 January 2019 and 31 December 2023, who received intravenous or subcutaneous SACT within 30 days of death, and a subgroup who received IO within 90 days of death. Demographic, oncological and mortality-related data were collected. Descriptive statistics and univariable logistic regression analyses were used.
RESULTS: Overall, 170 (5.8%) patients died within 30 days of receiving SACT. Thirty-seven (22%) deaths were attributed to treatment-related complications. Pre-treatment Eastern Co-operative Group Score 0-1 (odds ratio (OR) = 2.43, P = 0.03, 95% confidence interval (CI) 1.08-5.49) or chemotherapy administration (OR = 20.3, P < 0.001, 95% CI 4.58-89.97) were associated with TRM within 30 days of SACT. A total of 855 patients received IO containing regimens, of which 61 (7.1%) died within 30 days and 139 (16.3%) died within 90 days.
CONCLUSION: The proportion of patients who died within 30 days of SACT was comparable to that of previous Australian studies. TRM was associated with good pre-treatment performance status or chemotherapy administration. Prospective research should examine IO use at the end of life and evaluate optimal patient selection for SACT in larger Australian cohorts.
PMID:42550571 | DOI:10.1111/imj.70583
