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Factors associated with the initiation of chemotherapy within 90 days of death in metastatic colorectal cancer patients: a population-based study

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Abstract

Introduction

Initiation of chemotherapy in patients with cancer near end-of-life (EOL) has become more frequent due to an increasing number of treatment options. We aimed to analyze the proportion of metastatic colorectal cancer patients (mCRC) in Alberta, Canada, who were started on a new chemotherapy regimen within 90 days of death.

Methods

This was a retrospective, population-based study using data from the cancer measurement outcomes and evaluation (C-MORE) database. All patients who received chemotherapy for mCRC in a large Canadian province from January 1, 2011, to December 31, 2016, were included in the current analysis. We identified the proportion of patients who initiated chemotherapy near EOL. Further, we analyzed the associations of baseline factors with initiation of chemotherapy near EOL.

Results

We identified 511 patients with mCRC who received chemotherapy. Of these, 132 (25.8%) initiated chemotherapy near EOL. Charlson’s comorbidity index (CCI) score (score 1: OR, 0.524; 95% CI, 0.279–0.985; P = 0.045; CCI score > 1: OR, 0.366; 95% CI, 0.180–0.746; P = 0.006) and Eastern cooperative oncology group performance status (ECOG PS) (ECOG PS 2: OR, 4.457; 95% CI 2.518–7.890; P < 0.0001; ECOG PS > 2: OR 7.725; 95% CI 3.465–17.222; P < 0.0001) were predictive of initiation of chemotherapy near EOL. The most frequent chemotherapy regimens initiated were FOLFIRI (17%), capecitabine (15%), and panitumumab (15%), respectively.

Conclusions

Chemotherapy is frequently initiated near EOL in patients with mCRC. Routine clinical assessments including ECOG PS and comorbid medical conditions can help select patients with mCRC who are unlikely to benefit from palliative chemotherapy and prevent the adverse events and healthcare costs associated with such interventions near EOL.

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Authors and Affiliations

  1. Department of Medical Oncology, Tom Baker Cancer Center, 1331 29 ST NW, Calgary, Alberta, T2N 4N2, Canada

    Atul Batra & Winson Y. Cheung

  2. University of Calgary, Calgary, Alberta, Canada

    Atul Batra, Alkarim Billawala, Dropen Sheka, Shiying Kong & Winson Y. Cheung

  3. Queen’s University, Kingston, Ontario, Canada

    Geoff McKinnon

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  1. Atul Batra
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Contributions

Atul Batra: Conceptualization, analysis of data, writing, reviewing, and editing

Geoff McKinnon: Conceptualization, data collection, and writing

Alkarim Billawala: Data collection and writing

Dropen Sheka: Data collection and writing

Shiying Kong: Data collection and analysis

Winson Y. Cheung: Conceptualization, analysis of data, writing, reviewing, and editing

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Correspondence to Winson Y. Cheung.

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Ethical approval was obtained from Health Research Ethics Board of Alberta’s Cancer Committee prior to commencing the study.

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Batra, A., McKinnon, G., Billawala, A. et al. Factors associated with the initiation of chemotherapy within 90 days of death in metastatic colorectal cancer patients: a population-based study. Support Care Cancer 29, 1535–1542 (2021). https://doi.org/10.1007/s00520-020-05655-y

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