TY - JOUR
T1 - End-of-Life Use of Systemic Therapy in Patients With Advanced Melanoma
T2 - A Nationwide Cohort Study
AU - van Breeschoten, Jesper
AU - Ismail, Rawa K
AU - Wouters, Michel W J M
AU - Hilarius, Doranne L
AU - de Wreede, Liesbeth C
AU - Haanen, John B
AU - Blank, Christian U
AU - Aarts, Maureen J B
AU - van den Berkmortel, Franchette W P J
AU - de Groot, Jan Willem B
AU - Hospers, Geke A P
AU - Kapiteijn, Ellen
AU - Piersma, Djura
AU - van Rijn, Rozemarijn S
AU - Stevense-den Boer, Marion A
AU - van der Veldt, Astrid A M
AU - Vreugdenhil, Gerard
AU - Boers-Sonderen, Marye J
AU - Suijkerbuijk, Karijn P M
AU - UMC, Amsterdam
N1 - Publisher Copyright:
© American Society of Clinical Oncology.
PY - 2022/10
Y1 - 2022/10
N2 - PURPOSE: The introduction of immune checkpoint inhibitors and targeted therapies improved the overall survival of patients with advanced melanoma. It is not known how often these costly treatments with potential serious side effects are ineffectively applied in the last phase of life. This study aimed to investigate the start of a new systemic therapy within 45 and 90 days of death in Dutch patients with advanced melanoma.METHODS: We selected patients who were diagnosed with unresectable IIIC or stage IV melanoma, registered in the Dutch Melanoma Treatment Registry, and died between 2013 and 2019. Primary outcome was the probability of starting a new systemic therapy 45 and 90 days before death. Secondary outcomes were type of systemic therapy started, grade 3/4 adverse events (AEs), and the total costs of systemic therapies.RESULTS: Between 2013 and 2019, 3,797 patients with unresectable IIIC or stage IV melanoma were entered in the registry and died. The percentage of patients receiving a new systemic therapy within 45 and 90 days before death was significantly different between Dutch melanoma centers (varying from 6% to 23% and 20% to 46%, respectively). Thirteen percent of patients (n = 146) developed grade 3/4 AEs in the last period before death. The majority of patients with an AE required hospital admission (n = 102, 69.6%). Mean total costs of systemic therapy per cohort year of the patients who received a new systemic therapy within 90 days before death were 2.3%-2.8% of the total costs spent on melanoma therapies.CONCLUSION: The minority of Dutch patients with metastatic melanoma started a new systemic therapy in the last phase of life. However, the percentages varied between Dutch melanoma centers. Financial impact of these therapies in the last phase of life is relatively small.
AB - PURPOSE: The introduction of immune checkpoint inhibitors and targeted therapies improved the overall survival of patients with advanced melanoma. It is not known how often these costly treatments with potential serious side effects are ineffectively applied in the last phase of life. This study aimed to investigate the start of a new systemic therapy within 45 and 90 days of death in Dutch patients with advanced melanoma.METHODS: We selected patients who were diagnosed with unresectable IIIC or stage IV melanoma, registered in the Dutch Melanoma Treatment Registry, and died between 2013 and 2019. Primary outcome was the probability of starting a new systemic therapy 45 and 90 days before death. Secondary outcomes were type of systemic therapy started, grade 3/4 adverse events (AEs), and the total costs of systemic therapies.RESULTS: Between 2013 and 2019, 3,797 patients with unresectable IIIC or stage IV melanoma were entered in the registry and died. The percentage of patients receiving a new systemic therapy within 45 and 90 days before death was significantly different between Dutch melanoma centers (varying from 6% to 23% and 20% to 46%, respectively). Thirteen percent of patients (n = 146) developed grade 3/4 AEs in the last period before death. The majority of patients with an AE required hospital admission (n = 102, 69.6%). Mean total costs of systemic therapy per cohort year of the patients who received a new systemic therapy within 90 days before death were 2.3%-2.8% of the total costs spent on melanoma therapies.CONCLUSION: The minority of Dutch patients with metastatic melanoma started a new systemic therapy in the last phase of life. However, the percentages varied between Dutch melanoma centers. Financial impact of these therapies in the last phase of life is relatively small.
KW - Cohort Studies
KW - Death
KW - Humans
KW - Immune Checkpoint Inhibitors
KW - Immunotherapy
KW - Melanoma/drug therapy
UR - http://www.scopus.com/inward/record.url?scp=85139739101&partnerID=8YFLogxK
U2 - 10.1200/OP.22.00061
DO - 10.1200/OP.22.00061
M3 - Article
C2 - 35944229
SN - 2688-1527
VL - 18
SP - e1611-e1620
JO - JCO oncology practice
JF - JCO oncology practice
IS - 10
ER -