END-OF-LIFE CARE AGGRESSIVENESS IN PANCREATIC ADENOCARCINOMA: A RETROSPECTIVE OBSERVATIONAL STUDY
Author(s)
Valentina Danesi, PhD1, Andrea Roncadori, BSc, MSc2, Romina Rossi, MD3, Lucia Angelini, MD4, Paola Cravero, MD4, Linda Petrini, MSc4, Margherita Currà, MSc4, Vanessa Valenti, MSc4, William Balzi, MEng4, Marco Cesare Maltoni, MD3, Ilaria Massa, MSc4.
1Engineer, IRCCS Istituto Romagnolo per lo studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy, 2Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRST IRCCS, Meldola, Italy, 3University of Bologna, Bologna, Italy, 4IRCCS Istituto Romagnolo per lo studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy.
1Engineer, IRCCS Istituto Romagnolo per lo studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy, 2Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori IRST IRCCS, Meldola, Italy, 3University of Bologna, Bologna, Italy, 4IRCCS Istituto Romagnolo per lo studio dei Tumori (IRST) “Dino Amadori”, Meldola, Italy.
OBJECTIVES: To assess indicators of aggressive end-of-life care among patients with pancreatic adenocarcinoma and to identify associated care-related factors, with a focus on the timing of palliative care activation.
METHODS: We conducted a retrospective observational study of adult patients with pancreatic adenocarcinoma followed at IRST Hospital who died between 2019 and 2023. Administrative databases were used to identify the cohort and derive end-of-life care indicators. Aggressiveness of care was evaluated using selected Earle criteria (Earle CC, J Clin Oncol. 2003) and additional indicators. Associations were assessed using logistic regression models.
RESULTS: A total of 164 patients were included. At least one Earle criterion was fulfilled by 98 patients (59.8%), whereas 66 (40.2%) fulfilled none. Late activation of hospice or home-based palliative care within the last 3 days of life was observed in 82 patients. Systemic anticancer treatment near death was also frequent: 65 patients (39.6%) who received treatment in the last 30 days, 26 (15.9%) initiated a new treatment in the last 30 days, and 19 (11.6%) received treatment in the last 14 days. ICU admission, repeated emergency-urgency accesses, and repeated hospitalisations were uncommon. Palliative care activation between 31 and 90 days before death was associated with lower odds of treatment initiation in the last 30 days (OR 0.29, 95% CI 0.08-0.83) and higher odds of fulfilling none of the Earle criteria (OR 10.17, 95% CI 3.69-31.71). Activation more than 90 days before death was also associated with non-aggressive care (OR 4.07, 95% CI 1.86-9.14). Younger age was associated with a higher likelihood of receiving systemic anticancer treatment in the last 14 days of life
CONCLUSIONS: Aggressive end-of-life care was frequent and mainly driven by late or absent palliative care integration rather than intensive acute-care use. Earlier palliative care activation may improve end-of-life care quality in pancreatic cancer.
METHODS: We conducted a retrospective observational study of adult patients with pancreatic adenocarcinoma followed at IRST Hospital who died between 2019 and 2023. Administrative databases were used to identify the cohort and derive end-of-life care indicators. Aggressiveness of care was evaluated using selected Earle criteria (Earle CC, J Clin Oncol. 2003) and additional indicators. Associations were assessed using logistic regression models.
RESULTS: A total of 164 patients were included. At least one Earle criterion was fulfilled by 98 patients (59.8%), whereas 66 (40.2%) fulfilled none. Late activation of hospice or home-based palliative care within the last 3 days of life was observed in 82 patients. Systemic anticancer treatment near death was also frequent: 65 patients (39.6%) who received treatment in the last 30 days, 26 (15.9%) initiated a new treatment in the last 30 days, and 19 (11.6%) received treatment in the last 14 days. ICU admission, repeated emergency-urgency accesses, and repeated hospitalisations were uncommon. Palliative care activation between 31 and 90 days before death was associated with lower odds of treatment initiation in the last 30 days (OR 0.29, 95% CI 0.08-0.83) and higher odds of fulfilling none of the Earle criteria (OR 10.17, 95% CI 3.69-31.71). Activation more than 90 days before death was also associated with non-aggressive care (OR 4.07, 95% CI 1.86-9.14). Younger age was associated with a higher likelihood of receiving systemic anticancer treatment in the last 14 days of life
CONCLUSIONS: Aggressive end-of-life care was frequent and mainly driven by late or absent palliative care integration rather than intensive acute-care use. Earlier palliative care activation may improve end-of-life care quality in pancreatic cancer.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO214
Topic
Clinical Outcomes, Health Service Delivery & Process of Care, Real World Data & Information Systems
Topic Subcategory
Clinical Outcomes Assessment
Disease
Oncology