End-of-Life Care for Patients With Metastatic Renal Cell Carcinoma in the Era of Oral Anticancer Therapy.

Journal Article (Journal Article)

PURPOSE: New therapies including oral anticancer agents (OAAs) have improved outcomes for patients with metastatic renal cell carcinoma (mRCC). However, little is known about the quality of end-of-life (EOL) care and systemic therapy use at EOL in patients receiving OAAs or with mRCC. METHODS: We retrospectively analyzed EOL care for decedents with mRCC in two parallel cohorts: (1) patients (RCC diagnosed 2004-2015) from the University of North Carolina's Cancer Information and Population Health Resource (CIPHR) and (2) patients (diagnosed 2007-2015) from SEER-Medicare. We assessed hospice use in the last 30 days of life and existing measures of poor-quality EOL care: systemic therapy, hospital admission, intensive care unit admission, and > 1 ED visit in the last 30 days of life; hospice initiation in the last 3 days of life; and in-hospital death. Associations between OAA use, patient and provider characteristics, and EOL care were examined using multivariable logistic regression. RESULTS: We identified 410 decedents in the CIPHR cohort (53.4% received OAA) and 1,508 in SEER-Medicare (43.5% received OAA). Prior OAA use was associated with increased systemic therapy in the last 30 days of life in both cohorts (CIPHR: 26.5% v 11.0%; P < .001; SEER-Medicare: 23.4% v 11.7%; P < .001), increased in-hospital death in CIPHR, and increased hospice in the last 30 days in SEER-Medicare. Older patients were less likely to receive systemic therapy or be admitted in the last 30 days or die in hospital. CONCLUSION: Patients with mRCC who received OAAs and younger patients experienced more aggressive EOL care, suggesting opportunities to optimize high-quality EOL care in these groups.

Full Text

Duke Authors

Cited Authors

  • Dzimitrowicz, HE; Wilson, LE; Jackson, BE; Spees, LP; Baggett, CD; Greiner, MA; Kaye, DR; Zhang, T; George, D; Scales, CD; Pritchard, JE; Leapman, MS; Gross, CP; Dinan, MA; Wheeler, SB

Published Date

  • February 2023

Published In

Volume / Issue

  • 19 / 2

Start / End Page

  • e213 - e227

PubMed ID

  • 36413741

Pubmed Central ID

  • PMC9970274

Electronic International Standard Serial Number (EISSN)

  • 2688-1535

Digital Object Identifier (DOI)

  • 10.1200/OP.22.00401


  • eng

Conference Location

  • United States