End-of-life care quality indicators in advanced cancer patients at a Brazilian tertiary hospital.

Abstract

e24083 Background: Quality of end-of-life care in advanced cancer emphasizes timely palliative integration, symptom control, family engagement, advance directives, and avoidance of chemotherapy near death or intensive support. Intensive treatments or chemotherapy near death often reflect low-value care and missed palliative opportunities. This study aimed to evaluate the quality of EOL care among adult oncology inpatients who experienced in-hospital mortality at a private hospital in Brazil. Methods: This retrospective study at a private Brasília tertiary hospital expands prior analysis (N=197, Jan 2023 to Feb 2025) to full 2023-2025 (N=235), describing metrics and patient factors. Consists of a review of electronic health records of all adult oncology inpatients who experienced in-hospital mortality between January 2023 and December 2025 (N = 235) at a private hospital in Brazil. Data included demographics, cancer types, ECOG/PPS at admission, palliative follow-up, last-30-day chemotherapy, directives, symptom management, family conferences, artificial support, treatment intent. Data were analyzed descriptively, and associations between categorical variables were evaluated using the chi-square test. (p<0.05). Results: The median age of the patients was 73 years (range: 25-99), with females accounting for 52% of the sample. Poor functional status was common, with 55% presenting an ECOG performance status of 3-4. The most prevalent primary malignancies were pancreatic (13%), lung (10%), and colorectal cancer (9%). The main reasons for hospital admission were infection (46%) and cancer-related symptoms (40%). Almost all patients received palliative care support, with palliative team involvement documented in 99.6% of cases (234/235). Patients with last-30-day chemo were younger (median 68 vs 75 years; p=0.02), had higher ECOG (3.8 vs 3.2; p=0.03), lower PPS (40% vs 60%; p<0.01), and frequent pancreas/glioblastoma primaries. Conclusions: In this cohort, palliative care was integrated for almost all patients and was associated with effective symptom control and strong family involvement. Despite this, a substantial proportion received late chemotherapy, highlighting ongoing challenges in aligning end-of-life care with patient needs and clinical prognostic factors. Key indicators. Indicator n (%) Advance directives 82 (35) Symptom control 230 (98) Family conference 219 (93) Artificial support 42 (18) Palliative intent 183 (78) Chemo last 30 days 66 (28)