We hypothesized that advanced urothelial cancer patients would increasingly receive checkpoint inhibitors near the end of life, as they tend to have more favorable side effect profiles than chemotherapy. The study results confirmed this, showing a dramatic rise in checkpoint inhibitor utilization in patients in the last few months of life, particularly in patients with poor performance status.– Dr. Aaron Cohen, study co-author
Published in The Oncologist this week, our paper resulted from 6 months of research and analysis led by Dr. Ravi Parikh from the Abramson Cancer and Leonard Davis Institute at the University of Pennsylvania in collaboration with a team of research oncologists and scientists from Flatiron Health, Icahn School of Medicine, Queen’s University Cancer Research Center, and the Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center at Yale University.
Preface: Recently, @ASCO, @NatQualityForum, and others have released guidelines/metrics that argue against #chemotherapy at the #endoflife. Why? Such patients have worse quality of life, quality of death, and (obviously) don’t enjoy a survival benefit. See https://t.co/zk4HbY0iix— Ravi B. Parikh (@ravi_b_parikh) April 4, 2019
Figure 1 shows that in a group of 1,637 people with bladder cancer, the percent who had any immunotherapy (orange line) within the last 60 days of life is increasing over time. It looks like those patients are coming from a population that would have received no additional treatment in the time before immunotherapy was available (dashed line) and probably not substituting it for chemotherapy at the end of life (blue line).
Why this matters
These real-world findings give us unique insight into how practitioners view checkpoint inhibitors in relation to chemotherapy and have big implications for health care utilization and value frameworks in the end-of-life setting.
To cite this paper
Parikh RB, Galsky MD, Gyawali B, Riaz F, Kaufmann TL, Cohen AB, Adamson BJS, Gross CP, Meropol NJ, Mamtani R. Trends in Checkpoint Inhibitor Therapy for Advanced Urothelial Cell Carcinoma at the End of Life. The Oncologist. 2019;24:1-3. DOI: 10.1634/theoncologist.2019-0039; PubMed ID: 30944183.