End-of-Life Care for Patients With Metastatic Renal Cell Carcinoma in the Era of Oral Anticancer Therapy.

New therapies including oral anticancer agents (OAAs) have improved outcomes for patients with metastatic renal cell carcinoma (mRCC). However, little is known about the quality of end-of-life (EOL) care and systemic therapy use at EOL in patients receiving OAAs or with mRCC.

We retrospectively analyzed EOL care for decedents with mRCC in two parallel cohorts: (1) patients (RCC diagnosed 2004-2015) from the University of North Carolina's Cancer Information and Population Health Resource (CIPHR) and (2) patients (diagnosed 2007-2015) from SEER-Medicare. We assessed hospice use in the last 30 days of life and existing measures of poor-quality EOL care: systemic therapy, hospital admission, intensive care unit admission, and > 1 ED visit in the last 30 days of life; hospice initiation in the last 3 days of life; and in-hospital death. Associations between OAA use, patient and provider characteristics, and EOL care were examined using multivariable logistic regression.

We identified 410 decedents in the CIPHR cohort (53.4% received OAA) and 1,508 in SEER-Medicare (43.5% received OAA). Prior OAA use was associated with increased systemic therapy in the last 30 days of life in both cohorts (CIPHR: 26.5% v 11.0%; P < .001; SEER-Medicare: 23.4% v 11.7%; P < .001), increased in-hospital death in CIPHR, and increased hospice in the last 30 days in SEER-Medicare. Older patients were less likely to receive systemic therapy or be admitted in the last 30 days or die in hospital.

Patients with mRCC who received OAAs and younger patients experienced more aggressive EOL care, suggesting opportunities to optimize high-quality EOL care in these groups.

JCO oncology practice. 2022 Nov 22 [Epub ahead of print]

Hannah E Dzimitrowicz, Lauren E Wilson, Bradford E Jackson, Lisa P Spees, Christopher D Baggett, Melissa A Greiner, Deborah R Kaye, Tian Zhang, Daniel George, Charles D Scales, Jessica E Pritchard, Michael S Leapman, Cary P Gross, Michaela A Dinan, Stephanie B Wheeler

Department of Medicine, Duke University School of Medicine, Durham, NC., Department of Population Health Sciences, Duke University School of Medicine, Durham, NC., Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC., Department of Surgery (Urology), Duke University School of Medicine, Durham, NC., Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX., Department of Urology, Yale School of Medicine, New Haven, CT., Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT., Department of Medicine, Yale School of Medicine, New Haven, CT.