Aims
This study aimed to identify the application of futile anti-cancer therapy at a single institution through analysis of patients receiving anti-cancer therapies within the last four weeks of life and the setting and timing of Acute Resuscitation Plan (ARP) discussions at this institution.
Methods
Oncology patients at the Gold Coast University Hospital who died after receiving cytotoxic chemotherapy and/or immunotherapy between January 2018 and December 2019 were analysed for timing of treatment to death and ARP completion including setting (inpatient vs outpatient vs emergency department (ED)) and time-to-death.
Results
526 patients died after any treatment in the period analysed; 44.7% (235) were patients aged <65-years-old. 16.9% (89) died within 4 weeks of receiving treatment; 60% (53) were <65-years-old. 83.0% (437) patients received treatment >4 weeks before death; 23% (102) were <65-years-old. 90.0% (473) had documented ARPs, 44.3% of whom were <65. The majority (85.8%) were completed as in-patients, 4% in the ED and 10.1% as outpatients. Pertinently, 48.0% (227) of patients had ARPs completed within 4 weeks of death, and 52.0% (246) >4 weeks from death. In the outpatient setting, 62.9% (35) had their ARPs completed >4 weeks from dying, compared to 37.1% (13) <4 weeks of death. In those patients where an ARP discussion took place more than four weeks from death, 9.8% (24/246) received treatment within 4 weeks.
Conclusion
At our institution, a greater percentage of younger patients receive anti-cancer therapy versus older patients at end-of-life. Most patients had ARP discussions as in-patients; approximately half of all patients with ARPs died within 4 weeks of completed documentation; this appeared less likely when discussions were initiated in outpatients. Earlier advanced care planning may be a useful tool to initiate discussion regarding treatment goals, prevent futile treatments and are an on-going area for quality improvement.