Systemic anticancer therapy near the end of life: A binational multicenter analysis in Argentina and Uruguay.

Abstract

e24047 Background: Systemic anticancer therapy (SACT) near the end of life is considered a negative quality-of-care indicator, associated with limited survival benefit, increased toxicity, higher health care utilization, and delayed palliative care integration. Despite international recommendations, SACT close to death remains common. Multicenter Latin American data across different health care settings are scarce; a binational approach may help identify modifiable factors to improve the quality and value of end-of-life cancer care. Methods: This retrospective multicenter binational observational study (Argentina–Uruguay) included adults with advanced cancer who died between January 2022 and December 2023 and received systemic anticancer therapy during the last 90 days of life. The primary objective was to describe SACT exposure within 30 and 90 days before death as markers of therapeutic intensity. Clinical and treatment-related variables, as well as between-country differences, were analyzed. Results: A total of 249 patients were included (Argentina n = 173; Uruguay n = 76). Clinical characteristics and SACT use by country are shown in Table 1. Median age at death was similar between countries; however, patients in Uruguay more frequently had preserved ECOG performance status and were receiving first-line SACT, whereas patients in Argentina more often had ECOG PS ≥2 and received SACT in later treatment lines. In Uruguay, end-of-life SACT was mainly concentrated in tumors traditionally considered chemo-responsive (breast, colon, lung, gynecologic), while in Argentina it was distributed across a broader range of tumor types, affecting older and more heavily pretreated patients. Conclusions: SACT near the end of life was frequent in this binational cohort. Variability between Argentina and Uruguay suggests differences in health care contexts and clinical decision-making processes, with patterns of treatment intensity not explained solely by performance status or line of therapy. The high proportion of patients receiving first-line SACT followed by death shortly thereafter may reflect late diagnosis or delayed recognition of poor prognosis in the Uruguayan cohort. Conversely, more frequent SACT use in later lines in Argentina may be influenced by longer therapeutic trajectories and delayed integration of palliative care. These findings highlight the need to improve prognostic assessment, shared decision-making, and earlier palliative care integration to enhance the quality and value of end-of-life cancer care. Clinical characteristics and use of TOES by countr. Characteristics Argentina (n=173) Uruguay (n=76) Median age at death, years (range) 63 (23–92) 60 (30–85) ECOG PS 0–1 at last SACT (%) 42.4 64.5 ECOG PS ≥2 at last SACT (%) 57.2 35.5 First-line SACT at last treatment (%) 25.4 75.0 SACT ≤30 days before death (%) 31.2 39.5 SACT ≤90 days before death (%) 100 100