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End of Life Treatment of Metastatic Lung Cancer Patients in the Netherlands
PP-PDPI, 05 Ags 2019 19:50:07


Introduction: Systemic anti-cancer treatment in the last weeks of life is considered an indicator of aggressive end of life care. Internationally, a rise in aggressive treatment is seen, but information for European lung cancer patients is lacking.

Aim: We explored developments in treatment modalities and aggressive therapy for patients with metastatic lung cancer.

Methods: Patients with metastatic lung cancer (2005-2013) who died ≤9 months from diagnosis were selected from the Netherlands Cancer Registry. Aggressive treatment was defined as any form of active cancer treatment in the last month of life.

Results: The most prevalent treatments were best supportive care, systemic and metastasis treatment in both non-small cell (NSCLC) and small cell lung cancer (SCLC) (N=32,630). Most notable changes were a small increase in systemic treatment in NSCLC (33% in 2005-2007 to 36% in 2011-2013 (p<0.01) and increase of prophylactic brain irradiation in SCLC (2-13%, p< 0.01). Aggressive treatment remained stable at circa 30% for NSCLC, but for SCLC the proportion of aggressive treatment decreased (34 % in 2005-2007 to 27% in 2011-2013 (p=0.03). Survival benefit of patients treated with aggressive therapy compared to best supportive care was only 23 days.

Conclusions Among patients with metastatic lung cancer, best supportive care, systemic treatment and metastasis treatment remained the most common treatments. We did not find an increasing rate of aggressive treatment at the end of life. However, 30% were treated until very close to death and there was little survival benefit for those receiving aggressive treatment. The challenge remains predicting which patients will survive long enough to benefit from treatment.

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