ABSTRACT
Background: End of life medical treatment is an issue widely discussed in Oncology. There is little data about the indications for decision making between active treatment versus best supportive care. In this report we present our experience in patients (pts) who received oncologic treatment within the last 30 days of life. Material and methods: We retrospectively collected data of pts who have been hospitalized in the Medical Oncology Department of Istituto Nazionale Tumori of Milan receiving oncologic treatment from the 15th of November 2020 to the 15th of May 2021. We considered this period to mitigate the confusing effect of the SARS-Cov2 pandemic on the increase of mortality. We selected pts affected by any stage of cancer, who received any line of active cancer therapy within 30 days from death. We collected: age, sex, Performance Status according to the Eastern Cooperative Oncology Group (PS), type of cancer, line and type of treatment, Hemoglobin (Hb), White Blood Cells (WBC), Neutrophils (N), Platelets (PLT), Lactate Dehydrogenase (LDH), modified Glasgow Prognostic Score (mGPS) calculated with Albumine and C Reactive Protein, and cause of death. Results: In total 263 pts were hospitalized. Of these, 166 have received oncologic treatment. Of them, 9 pts (5.4%) died within 30 days of treatment. Among them, the mean age was 64 years, 4 pts were women (44%) while 5 were men (56%). Three pts were PS 1 (33%), 3 pts were PS 2 (33%) and 3 pts were PS 3 (33%). All pts were affected by advanced cancer;7 pts had lung cancer (78%), 1 gastric cancer (11%) and 1 breast cancer (11%). Four pts (44%) received first line therapy and 5 pts (56%) further line therapy. Five pts were treated with chemotherapy (56%), 3 pts with immunotherapy (33%), 1 with chemo-immunotherapy (11%). Considering the blood tests, median WBC count was 9680/μL (1080 - 33820), median N levels were 8860/μL (3780 - 31520), median Hb was 11.2 g/dL (9-15), median PLT count was 314 000/μL (196 000 - 413 000) and median LDH was 216 U/L (150 - 1372). mGPS were 2 in 5 pts (56%), 1 in 2 pts (22%) and 0 in 2 pts (22%). Causes of death were progression (78%), toxicity (11%) and other causes (infection, 11%). Conclusions: Our study is consistent with available literature about end of life oncologic treatment. Based on our data, pts' selection according to PS and mGPS should not be the only parameter to consider for treatment decisions. A comprehensive characterization of the pts treatment must be studied.