Outpatient palliative care consultation and end-of-life outcomes among a retrospective cohort of patients treated with immunotherapy for non-small cell lung cancer.

Abstract

12082 Background: Immune checkpoint inhibitors (ICIs) have been shown to be effective against a wide range of cancers and are available to most patients due to their favorable side effect profile. Studies have shown that palliative care consultation prolongs overall survival (OS) in patients with advanced cancer, but most of these studies assessed cytotoxic chemotherapy and not ICIs. Other studies have shown that outpatient palliative care consultation (OPCC) has a greater effect on a variety of end-of-life outcomes than in the inpatient setting. Our study aims to analyze the association between OPCC and survival in patients with lung cancer treated with an ICI. Methods: We designed a retrospective registry of all patients at a comprehensive cancer center and its outreach clinics who received one or more doses of an ICI. The investigators created a secure, cloud-based registry (REDCap), validated it with data quality rules, resolved all discrepancies, and obtained data on palliative care encounters; clinical research specialists at Vasta Global (New York, NY) captured most of the data. Comparisons were made using chi-square or Fisher’s exact for categorical variables. Cox proportional hazards model was built controlling for confounders. Survival time for patients with palliative visits was only considered after initial OPCC. Statistical significance was defined as p < 0.05. The study had institutional IRB approval. Results: Our cohort consisted of 1,114 patients with non-small cell lung cancer, 55% of whom were metastatic at diagnosis. 6% (n = 70) of the patients had an OPCC at some point after their diagnosis. When controlling for stage at diagnosis and age, OPCC was associated with an adjusted hazard ratio of 0.57 (95% CI 0.34-0.98). None of the patients with OPCC received ICI within 14 days of death compared to 6.5% of those without OPCC (p = 0.018). Similarly, only 2.9% of those with OPCC received ICI within 30 days of death, compared to 16.4% of those without OPCC (p = 0.003). Conclusions: In patients with lung cancer treated with ICI, OPCC was associated with improved OS regardless of age or stage at diagnosis. Our analysis also showed that patients who received OPCC were less likely to receive ICI near the end of life. It is possible that OPCC may prolong survival by decreasing the ineffective use of aggressive care at the end of life. Further research is needed to clarify the relationship between OPCC and cancer outcomes.