TY - JOUR
T1 - High-Intensity Care in the End-of-Life Phase of Castration-Resistant Prostate Cancer Patients
T2 - Results from the Dutch CAPRI-Registry
AU - Westgeest, Hans M
AU - Kuppen, Malou C P
AU - van den Eertwegh, Fons A J M
AU - van Oort, Inge M
AU - Coenen, Juleon L L M
AU - van Moorselaar, Jeroen R J A
AU - Aben, Katja K H
AU - Bergman, Andre M
AU - Huinink, Daan Ten Bokkel
AU - van den Bosch, Joan
AU - Hendriks, Mathijs P
AU - Lampe, Menuhin I
AU - Lavalaye, Jules
AU - Mehra, Niven
AU - Smilde, Tineke J
AU - Somford, Rik D M
AU - Tick, Lidwine
AU - Weijl, Nir I
AU - van de Wouw, Yes A J
AU - Gerritsen, Winald R
AU - Groot, Carin A Uyl-de
N1 - Funding Information: M.C.P.K. has received travel/accommodation expenses from Ipsen; H.M.W. has received travel/accommodation expenses from Ipsen and honoraria from Roche. F.A.J.M.v.d.E. has received study grants from Sanofi and Roche; travel expenses from MSD Oncology, Roche, Pfizer and Sanofi; honoraria from Bristol-Myers Squibb; and is a member of the advisory board of Bristol-Myers Squibb, MSD Oncology, Amgen, Roche, Novartis, Sanofi, Pfizer, Ipsen, and Merck. I.M.v.O. has received study grants from Astellas, Janssen, and Bayer, and has a consulting/advisory role for Astellas, Jans-sen, Bayer, Roche, and Mdx health. J.L.L.M.C. is a member of the advisory board of Sanofi. J.R.J.A.v.M. has received honoraria/consultation fees of Astellas, AstraZeneca, Bayer, Janssen, and Sanofi-Genzyme. K.K.H.A. has no conflict of interest. A.M.B. has received study grants from Sanofi, As-tellas, and Bayer; travel/accommodation expenses from Sanofi, Astellas, and Bayer; speaker fees of Sanofi, Astellas, Bayer, and Janssen; and has an consulting/advisory role for Sanofi, Astellas, and Bayer. D.t.B.H. has no conflict of interest. J.v.d.B. has no conflict of interest. M.P.H. has no conflict of interest. M.I.L. has no conflict of interest. J.L. has no conflict of interest. N.M. has received study grants from Astellas, Janssen, Pfizer, Roche, and Sanofi Genzyme; has a consulting/advisory role for Roche, MSD, BMS, Bayer, Astellas, and Janssen; and has received travel/accommodation expenses from Astellas and MSD. T.J.S. has no conflict of interest. R.D.M.S. has received study grants from Astellas and honoraria from Astellas and Janssen. L.T. has no conflict of interest. N.I.W. has no conflict of interest. Y.A.J.v.d.W. has no conflict of interest. W.R.G. has received speaker’s fees from Bayer and MSD; study grants from Bayer, As-tellas, and Janssen-Cilag; and is a member of the advisory board of Bristol-Myers Squibb, Astellas, Bayer, Sanofi, and Amgen. C.A. U.-d.G. has received study grants from Boehringer Ingelheim, Astellas, Celgene, Sanofi, Janssen-Cilag, Bayer, Amgen, Genzyme, Merck, Glycostem Therapeutics, Astra Zeneca, and Roche. Funding Information: This research was funded by Sanofi-Aventis Netherlands B.V., Janssen-Cilag B.V., Astellas Pharma B.V., and Bayer B.V. The funding organizations had no role in the design and conduct of the study, collection, management, analysis, interpretation of the data, and preparation, review, or approval of the abstract. Publisher Copyright: © Copyright 2021, Mary Ann Liebert, Inc., publishers 2021.
PY - 2021/12
Y1 - 2021/12
N2 - Background: Intensive end-of-life care (i.e., the overuse of treatments and hospital resources in the last months of life), is undesirable since it has a minimal clinical benefit with a substantial financial burden. The aim was to investigate the care in the last three months of life (end-of-life [EOL]) in castration-resistant prostate cancer (CRPC). Methods: Castration-resistant prostate cancer registry (CAPRI) is an investigator-initiated, observational multicenter cohort study in 20 hospitals retrospectively including patients diagnosed with CRPC between 2010 and 2016. High-intensity care was defined as the initiation of life-prolonging drugs (LPDs) in the last month, continuation of LPD in last 14 days, >1 admission, admission duration ≥14 days, and/or intensive care admission in last three months of life. Descriptive and binary logistic regression analyses were performed. Results: High-intensity care was experienced by 41% of 2429 patients in the EOL period. Multivariable analysis showed that age (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.97-0.99), performance status (OR 0.57, 95% CI 0.33-0.97), time from CRPC to EOL (OR 0.98, 95% CI 0.97-0.98), referral to a medical oncologist (OR 1.99, 95% CI 1.55-2.55), prior LPD treatment (>1 line OR 1.72, 95% CI 1.31-2.28), and opioid use (OR 1.45, 95% CI 1.08-1.95) were significantly associated with high-intensity care. Conclusions: High-intensity care in EOL is not easily justifiable due to high economic cost and little effect on life span, but further research is awaited to give insight in the effect on patients' and their caregivers' quality of life.
AB - Background: Intensive end-of-life care (i.e., the overuse of treatments and hospital resources in the last months of life), is undesirable since it has a minimal clinical benefit with a substantial financial burden. The aim was to investigate the care in the last three months of life (end-of-life [EOL]) in castration-resistant prostate cancer (CRPC). Methods: Castration-resistant prostate cancer registry (CAPRI) is an investigator-initiated, observational multicenter cohort study in 20 hospitals retrospectively including patients diagnosed with CRPC between 2010 and 2016. High-intensity care was defined as the initiation of life-prolonging drugs (LPDs) in the last month, continuation of LPD in last 14 days, >1 admission, admission duration ≥14 days, and/or intensive care admission in last three months of life. Descriptive and binary logistic regression analyses were performed. Results: High-intensity care was experienced by 41% of 2429 patients in the EOL period. Multivariable analysis showed that age (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.97-0.99), performance status (OR 0.57, 95% CI 0.33-0.97), time from CRPC to EOL (OR 0.98, 95% CI 0.97-0.98), referral to a medical oncologist (OR 1.99, 95% CI 1.55-2.55), prior LPD treatment (>1 line OR 1.72, 95% CI 1.31-2.28), and opioid use (OR 1.45, 95% CI 1.08-1.95) were significantly associated with high-intensity care. Conclusions: High-intensity care in EOL is not easily justifiable due to high economic cost and little effect on life span, but further research is awaited to give insight in the effect on patients' and their caregivers' quality of life.
KW - castration-resistant prostate cancer
KW - end-of-life care
KW - high-intensity care
KW - hospital admission
KW - life-prolonging drugs
UR - http://www.scopus.com/inward/record.url?scp=85121446753&partnerID=8YFLogxK
U2 - https://doi.org/10.1089/jpm.2020.0800
DO - https://doi.org/10.1089/jpm.2020.0800
M3 - Article
C2 - 34415798
SN - 1096-6218
VL - 24
SP - 1789
EP - 1797
JO - Journal of palliative medicine
JF - Journal of palliative medicine
IS - 12
ER -