Author(s)
Leeneman B1, Franken M1, Aarts MJ2, van Akkooi AC3, van den Berkmortel FW4, van den Eertwegh AJ5, de Groot JW6, Herbschleb KH7, van der Hoeven KJ7, Hospers GA8, Kapiteijn E9, Piersma D10, van Rijn RS11, Suijkerbuijk KP12, ten Tije AJ13, van der Veldt AA14, Vreugdenhil G15, Wouters MW3, van Zeijl MC16, Haanen JB3, Uyl-de Groot CA1
1Erasmus University Rotterdam, Rotterdam, The Netherlands, 2Maastricht University Medical Center+, Maastricht, The Netherlands, 3Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands, 4Zuyderland Medical Center Geleen – Heerlen, Sittard-Geleen, The Netherlands, 5VU University Medical Center, Amsterdam, The Netherlands, 6Isala, Zwolle, The Netherlands, 7Radboud University Medical Center, Nijmegen, The Netherlands, 8University Medical Center Groningen, Groningen, The Netherlands, 9Leiden University Medical Center, Leiden, The Netherlands, 10Medisch Spectrum Twente, Twente, The Netherlands, 11Medical Center Leeuwarden, Leeuwarden, The Netherlands, 12University Medical Center Utrecht, Utrecht, The Netherlands, 13Amphia Hospital, Breda, The Netherlands, 14Erasmus MC Cancer Institute, Rotterdam, The Netherlands, 15Maxima Medical Center, Eindhoven, The Netherlands, 16Dutch Institute for Clinical Auditing, Deventer, The Netherlands
OBJECTIVES: Decision making in end-of-life care is complex because of the delicate trade-off between benefits for patients and healthcare investments. We investigated end-of-life care in metastatic cutaneous melanoma patients in The Netherlands. METHODS: Data were retrieved from the population-based Dutch Melanoma Treatment Registry. We included all metastatic cutaneous melanoma patients diagnosed between July 2012 and December 2017. End-of-life care was investigated with respect to the use of systemic therapy, radiation therapy, surgery, and hospital admissions in the last three months before death. RESULTS: Of the 3,860 melanoma patients, 2,276 patients (59%) died. Sixty-three percent (n=1,444) received systemic therapy in the last three months before death of whom 741 patients (51%) started within the last three months. Of these patients, 39% started a first-line therapy, 33% a second-line therapy, and 28% a third-line therapy or higher. Most patients started a BRAF inhibitor (26%), ipilimumab (22%) or an anti-PD-1 antibody (18%). Twelve percent of the patients (n=88) experienced at least one grade 3 or 4 treatment-related adverse event (TRAE). Of all patients who started systemic therapy within the last three months, 77% had at least one hospital admission (mean duration: 8.3 days), 31% had radiation therapy, and 5% had surgery. Hospital admissions and radiation therapy were less common in patients who started systemic therapy longer than three months before death (47% and 22%, respectively) and patients who did not receive systemic therapy in the last three months (42% and 26%, respectively). The mean hospital duration and percentage of patients who had surgery were comparable between the patient groups. CONCLUSIONS: About one-third of all deceased melanoma patients started systemic therapy in the last three months before death. These patients had more hospital admissions than other patients. Only a few patients experienced grade 3 or 4 TRAEs. These insights may facilitate complex decision making in end-of-life care.
Conference/Value in Health Info
2018-11, ISPOR Europe 2018, Barcelona, Spain
Value in Health, Vol. 21, S3 (October 2018)
Code
PCN220
Topic
Economic Evaluation, Health Policy & Regulatory, Health Service Delivery & Process of Care, Study Approaches
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Health Care Research, Health Disparities & Equity, Hospital and Clinical Practices, Prescribing Behavior, Quality of Care Measurement, Registries, Treatment Patterns and Guidelines
Disease
Oncology
