End-of-life anti-cancer treatment (Rx) patterns in patients (pts) with the six most common cancers in the USA.

Abstract

12034 Background: Pts with ≤ 6 months of life expectancy qualify for hospice. However, most pts with advanced/metastatic (a/m) cancer continue to receive Rx up to weeks prior to death. Data describing end-of-life Rx patterns in these pts remain limited but are essential to improve clinical care delivery. Herein, we evaluated real-world Rx patterns in relation to the time of death across 6 most common a/m solid tumors: advanced non-small cell lung cancer (aNSCLC), metastatic breast cancer (mBC), metastatic prostate cancer (mPC), advanced colorectal cancer (aCRC), metastatic pancreatic cancer (mPanC), and advanced urothelial carcinoma (aUC). Methods: This study used the US-based, electronic health record-derived deidentified Flatiron Health Research Database. Eligibility: diagnosis of aNSCLC, mBC, mPC, aCRC, mPanC and aUC, had a recorded date of death, and information on initiation of first-line (1L) Rx. The data cutoff date was 6/30/2025. Pts were categorized as treatment-free if no systemic Rx was administered within the final 1 or 3 months of life, or on-treatment if systemic Rx was received within 1 or 3 months before death. Demographic and clinical variables at the last line of Rx initiation, including age, race, socioeconomic status, practice type, and insurance, were summarized using medians (IQR) or proportions. Results: Of 111,337 pts with aNSCLC, 82,339 had a recorded date of death, of whom 59,777 initiated 1L Rx. Of 43,218 pts with mBC, 26,572 had a recorded date of death, of whom 23,055 initiated 1L Rx. Of 27,979 pts with mPC, 14,793 had a recorded date of death, of whom 9,667 initiated 1L Rx. Of 45,013 pts with aCRC, 29,749 had a recorded date of death, of whom 24,219 initiated 1L Rx. Of 18,942 pts with mPanC, 15,690 had a recorded date of death, of whom 11,528 initiated 1L Rx. Of 15,236 pts with aUC, 10,872 had a recorded date of death, of whom 7,815 initiated 1L Rx. The proportion of pts receiving systemic Rx within 1 month or 3 months before death for each cancer type is summarized in Table. Baseline characteristics, Rx patterns and trends by cancer type will be presented at the meeting. Conclusions: Across six most common cancers in the US, systemic Rx use remained common near the end of life, with up to one-third of pts treated in the final month. These findings suggest the need for greater emphasis on early involvement of palliative care teams and timely transition of pts with terminal cancers to comfort care. Proportion of pts with a/m cancer receiving systemic Rx within 1 month or 3 months before death. Cancer type Eligible pts Rx within 1 month of death, n (%) Rx within 3 months of death, n (%) aNSCLC 59,777 19,268 (32.2) 38,227 (63.9) mBC 23,055 8,416 (36.5) 15,972 (69.3) mPC 9,667 2,438 (25.2) 5,762 (59.6) aCRC 24,219 7,172 (29.6) 15,386 (63.5) mPanC 11,528 4,191 (36.3) 9,184 (79.7) aUC 7,815 2,358 (30.2) 5,170 (66.1)