High-Intensity Care in the End-of-Life Phase of Castration-Resistant Prostate Cancer Patients: Results from the Dutch CAPRI-Registry

Hans Westgeest, Malou Kuppen, Fons A.J.M. Van Den Eertwegh, Ige M. van Oort, Juleon L.L.M. Coenen, Jeroen R.J.A. Van Moorselaar, Katje K.H. Aben, Andre M. Bergman, Daan Ten Bokkel Huinink, Joan Van Den Bosch, Mathijs P. Hendriks, Menuhin I. Lampe, Jules Lavalaye, Niven Mehra, Tineke J. Smilde, Rik D.M. Somford, Lidwine Tick, Nir I. Weijl, Yes A.J. Van De Wouw, Winald R. GerritsenCA (Carin) Uyl - de Groot

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Abstract

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.
Original languageEnglish
Pages (from-to)1789-1797
Number of pages9
JournalJournal of Palliative Medicine
Volume24
Issue number12
Early online date19 Aug 2021
DOIs
Publication statusPublished - 17 Nov 2021

Bibliographical note

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.

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