Endocrine treatment near the end of life among older women with metastatic breast cancer: a nationwide cohort study

Máté Szilcz; Jonas W Wastesson; Amaia Calderón-Larrañaga; Lucas Morin; Henrik Lindman; Kristina Johnell

doi:10.3389/fonc.2023.1223563

Endocrine treatment near the end of life among older women with metastatic breast cancer: a nationwide cohort study

Front Oncol. 2023 Oct 9:13:1223563. doi: 10.3389/fonc.2023.1223563. eCollection 2023.

Authors

Máté Szilcz¹, Jonas W Wastesson^{1

2}, Amaia Calderón-Larrañaga^{2

3}, Lucas Morin^{1

4

5}, Henrik Lindman⁶, Kristina Johnell¹

Affiliations

¹ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
² Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet & Stockholm University, Stockholm, Sweden.
³ Stockholm Gerontology Research Center, Stockholm, Sweden.
⁴ Inserm CIC 1431, University Hospital of Besançon, Besançon, France.
⁵ Inserm U1018, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Villejuif, France.
⁶ Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology; Clinical Oncology, Faculty of Medicine, Uppsala University Hospital, Uppsala, Sweden.

Abstract

Background: The appropriate time to discontinue chemotherapy at the end of life has been widely discussed. In contrast, few studies have investigated the patterns of endocrine treatment near death. In this study, we aimed to investigate the end-of-life endocrine treatment patterns of older women with metastatic breast cancer and explore characteristics associated with treatment.

Methods: A retrospective cohort study of all older women (age ≥65 years) with hormone receptor-positive breast cancer who died in Sweden, 2016 - 2020. We used routinely collected administrative and health data with national coverage. Treatment initiation was defined as dispensing during the last three months of life with a nine-month washout period, while continuation and discontinuation were assessed by previous use during the same period. We used log-binomial models to explore factors associated with the continuation and initiation of endocrine treatments.

Results: We included 3098 deceased older women with hormone receptor-positive breast cancer (median age 78). Overall, endocrine treatment was continued by 39% and initiated by 5% and of women during their last three months of life, while 31% discontinued and 24% did not use endocrine treatment during their last year of life. Endocrine treatment continuation was more likely among older and less educated women, and among women who had multi-dose drug dispensing, chemotherapy, and CDK4/6 use. Only treatment-related factors were associated with treatment initiation.

Conclusion: More than a third of women with metastatic breast cancer continue endocrine treatments potentially past the point of benefit, whereas late initiation is less frequent. Further research is warranted to determine whether our results reflect overtreatment at the end of life once patients' preferences and survival prognosis are considered.

Keywords: Sweden; end of life; endocrine treatment; metastatic breast cancer; overtreatment; palliative care.

Grants and funding

This work was supported by funding from the Swedish Research Council for Health, Working Life and Welfare (FORTE) and KID-funding. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.