Post Notification Withdrawal Clinical Oncology Society of Australia Annual Scientific Meeting 2020

Systemic therapy at end of life in patients with solid organ malignancy  (#241)

Omali Pitiyarachchi 1 2 , Brandon Lau 1 2 3 4 , Prunella Blinman 2 5 , Steven Kao 1 5 6
  1. Chris O'Brien Lifehouse, Camperdown, NSW, Australia
  2. Concord Cancer Centre, Concord, NSW, Australia
  3. Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
  4. Kinghorn Cancer Centre, Sydney, NSW, Australia
  5. University of Sydney, Sydney, NSW, Australia
  6. Asbestos Diseases Research Institute, Sydney, NSW, Australia


Despite advances in anticancer therapy, many patients will die of their disease and maintaining QOL is paramount1. In keeping with the Quality Oncology Practice Initiative of ASCO, an important factor is appropriately timed cessation of chemotherapy2. A common quality assurance indicator used is for <10% of patients to receive chemotherapy in the last 2 weeks of life3. With immunotherapy now readily available, the impact on these figures and quality of end of life care is less clear. 


To assess the rate of anticancer treatment within the last 2 and 4 weeks of life. To assess patient, disease, and clinical factors, as well as quality measures, and any associations between these. 


A retrospective review of the medical record was undertaken to identify patients known to the oncology service of two metropolitan centres, who died from advanced cancer between 01/01/2018 - 01/01/2020. Patients who received anti-cancer treatment within 2 and 4 weeks of death were identified, and patient, disease and clinical factors were assessed. 


534 total deaths were identified. 92 patients received anti-cancer treatment within 4 weeks of death (51 chemotherapy, 26 immunotherapy, 21 oral). 39 patients received anti-cancer treatment within 2 weeks of death. Further associations with patient, disease, and clinical factors including age, gender, tumour type, treating clinician and centre, and quality indicators such as hospitalisation or ED visits, ICU admissions within 30 days of death, referral to palliative care, and documentation of an advanced care directive, will be analysed and presented at the meeting. 


Based on our data, only 7% of patients received anti-cancer treatment in the last 2 weeks of life which is in line with the ASCO QOPI guideline. Despite immunotherapy being more readily available, there does not seem to be more frequent use at the end of life.

  1. ASCO Quality Oncology Practice Initiative. QOPI-related measures. 2020.
  2. Earle CC, Park ER, Lai B et al. Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol 2003; 21: 1133–1138
  3. Earle CC, Neville BA, Landrum MB et al. Evaluating claims-based indicators of the intensity of end-of-life cancer care. Int J Qual Health Care 2005; 17: 505–509