Background: An important facet of cancer care is recognising when to transition the focus of care from life prolonging therapies to best supportive care. The 30-day mortality rate from Systemic Anti-Cancer Therapy (SACT) may help identify where such patient care can improve. In this retrospective audit we aim to quantify the proportion of patients at Frankston Hospital who received SACT within their last 30 days to identify any characteristics which may highlight unmet need.
Methods: Medical records were obtained for all patients who died on the Oncology ward, or were transferred to inpatient palliative care, between 01 January 2013 to 31 December 2017. Ethics approval was obtained to collect data for: demographics, tumour characteristics, administration, SACT (intent, treatment dates), location of death, and palliative care involvement. A multi-variate statistical analysis was performed to identify factors associated with SACT within the last 30 days.
Results: During the study period, 533 oncology patients died during a hospital admission. After screening incomplete datasets, 512 (277 male and 235 female) were eligible for audit. Chemotherapy was received by 23%. Patients receiving SACT were younger (65y vs. 68y), more likely to die in the acute hospital (71% vs. 43%) and less likely to be known to palliative care (51% vs. 66%). Only 25% patients in both groups had an advanced care plan.
Conclusion: Our rate of SACT in the 30 days prior to death is comparable with published literature. The true rate may be lower due to the lack of data on patients dying at home. Patients receiving SACT in the 30 days before death were less likely to have active palliative care involvement and were more likely to die in the acute hospital. Earlier involvement of palliative care may reduce futile treatment use and improve cancer care coordination.