Patients with Metastatic Breast Cancer and the Use of Chemotherapy During End of Life

Recognition of the common use of chemotherapy and its potential negative impact on quality of life during the final month of life of patients with metastatic breast cancer is essential to efforts to mitigate this practice.

The use of chemotherapy in patients with metastatic breast cancer during end of life may negatively impact quality of life and cause unnecessary toxicity. However, available data during the final month of life is scarce. Luisa Edman Kessler of Stockholm, Sweden, and colleagues sought to inform on the patterns of chemotherapy use and the associated clinical and demographic characteristics of patients with metastatic breast cancer during the last month of life in Sweden and Greece.

Data regarding clinical characteristics, survival, and use of chemotherapy during the final 30 days of life were collected for this retrospective cohort study. For the Swedish cohort, 1571 patients diagnosed with metastatic breast cancer were identified from the Stockholm-Gotland population-based Breast Cancer Registry and treatment data were collected using hospital charts. For the Greek cohort, 966 patients with metastatic breast cancer were identified from hospital charts at 2 hospitals in Athens and Crete.

In the Swedish cohort, 23.2% of patients were treated with at least 1 dose of chemotherapy and a new chemotherapy regimen was initiated during the final 30 days of life in 8.4% of patients. Capecitabine or vinorelbine monotherapy was most commonly used. A median overall survival of 16.96 months (95% confidence interval [CI], 15.4-18.4) was observed. Conversely, 46.5% of the Greek cohort received chemotherapy, with 19.5% of patients starting a new chemotherapy regimen at the end of life. The most common therapy was intravenous drug combinations. The median overall survival was 49.8 months (95% CI, 45.6-54.1). Younger age and higher albumin levels were statistically significantly associated with chemotherapy use during end of life in the Swedish cohort. There was no association between age, receptor status, or number of treatment lines and the likelihood of receiving chemotherapy at the final 30 days of life in the Greek cohort.

Use of a wide variety of chemotherapy near the end of life that might negatively impact patient quality of life was fairly common in patients with metastatic breast cancer.

Source: Kessler EL, Sigfridsson J, Hatzidaki D, et al. Chemotherapy use near the end‑of‑life in patients with metastatic breast cancer. Breast Cancer Res Treat. 2020;181:645-651.