Determinants of Systemic Anticancer Treatment and Continuous Intravenous Opioid and/or Benzodiazepine Use at End of life: A Real-World Analysis of Demographic and Clinical Factors in Advanced Cancer Patients.
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BACKGROUND: Systemic-anticancer-treatment (SACT) near the end of life (EOL) remains common despite limited evidence of meaningful survival benefit and concerns regarding treatment-related toxicity and quality of life. Here, we aimed to identify demographic and clinical factors associated with SACT and continuous intravenous opioid and/or benzodiazepine use at EOL, with a specific focus on adolescent and young adult (AYA) patients. METHODS: In this retrospective cohort study adult patients with cancer treated with palliative intent at the Medical University of Vienna between 2013 and 2021 were included. SACT at EOL was defined as systemic antineoplastic therapy administered ≤30 days before death. Continuous intravenous opioid and/or benzodiazepine use at EOL was defined as ongoing hydromorphone, morphine and/or midazolam administration via syringe pump at the time of death. Univariable and multivariable logistic regression analyses were performed. A predefined subgroup analysis examined AYA patients (<40 years). RESULTS: Among 775 patients (median age 65 years; 51% female), 358 (46%) SACT within 30 days before death. In multivariable analysis, younger age (OR 0.99 per year increase, 95% CI 0.98-1.00, p=0.043) and male sex (female vs male: OR 0.64, 95% CI 0.48-0.85, p=0.002) were independently associated with SACT at EOL. In a sensitivity analysis, AYA status was associated with higher odds of SACT (OR 2.32, 95% CI 1.32-4.23, p=0.004). Continuous intravenous opioid and/or benzodiazepine use at EOL was documented in 343 patients (44%); recent SACT was independently associated with higher odds of medication use (OR 4.93, 95% CI 3.63-6.74, p<0.001). Among 55 AYA patients (7.1%), SACT (65% vs 45%) and continuous intravenous opioid and/or benzodiazepine use (67% vs 43%) were more frequent than among non-AYA patients aged ≥40 years. CONCLUSION: SACT at EOL remains common and was independently associated with younger age and male sex. AYA patients also showed higher odds of SACT in a sensitivity analysis, although this finding should be interpreted cautiously given the small subgroup size. Higher rates of both interventions among AYA patients highlight the need for early, age- and sex-sensitive palliative care integration.