MO2-7-5Quality of medical care in end-of-life lung cancer patients previously received immunotherapy

Abstract Background Immuno-oncology has changed disease trajectory as well as prognosis. End-of-life(EOL) care and EOL discussion must be changed, but little is known about current situation in the real world. The aim of this study is to explore the quality of medical care in end stage lung cancer patients who had received immunotherapy (IT). Methods This is a retrospective chart review. We reviewed the data of lung cancer patients who had received IT and died in our hospital between January 2014 and December 2018. The coprimary outcome are the length of stay in hospital and at home within 30 days from death. Results We identified 77 patients who met the eligible criteria. Their characteristics were as follows: median age, 63(34-78) years, male/female, 53/24 cases, histology type were Ad/Sq/Others, 55/14/8 cases. Patient received 1(1-2) regimens and 2(1-41) cycles of IT. Nivolumab, 46 cases (59%), was the most used IT agent. Most of the patients (92%) lived with their family and about half (52%) of them lived in Tokyo. The median overall survival from the initial diagnosis was 474 (25-4889) days and the median duration between final administration of IT and death was 58 (2-626) days. Within 30 days of death, the number of emergency hospitalizations was 1 (0-2) times, the length of hospital stay was 18 (1-30) days, the length of staying at home was 12 (0-29) days. Eighteen cases (23%) were hospitalized for 30 days or more consecutively until the death. Although fifteen(83%) out of 18 cases hospitalized for palliative care, only 6 cases received palliative care team (PCT) intervention. The most common reasons for emergency hospitalization were dyspnea (33 cases, 42%). Forty-five patients (58%) had meetings with medical social workers(MSWs). Six cases were able to go back home with visiting medical care. Conclusion Percentage of intervention by PCT is low. And the intervention of MSWs is too late. To improve this situation, EOL discussion should be started earlier.