Use of cancer-directed therapy at the end of life among adolescents and young adults.

Autor:	Mack JW; Division of Population Sciences, Department of Medical Oncology, and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA., Cernik C; Division of Population Sciences, Department of Medical Oncology, and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA., Xu L; MedHealth Statistical Consulting Inc, Solon, OH, USA., Laurent CA; Division of Research, Department of Research and Evaluation, Kaiser Permanente Northern California, Oakland, CA, USA., Fisher L; Division of Population Sciences, Department of Medical Oncology, and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA., Cannizzaro N; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA., Munneke J; Division of Research, Department of Research and Evaluation, Kaiser Permanente Northern California, Oakland, CA, USA., Cooper RM; Department of Pediatric Oncology, Kaiser Permanente Southern California, Pasadena, CA, USA., Lakin JR; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA., Schwartz CM; Division of Medical Oncology, Department of Medicine, Kaiser Permanente Northern California, Oakland, CA, USA., Casperson M; Cactus Cancer Society (cactuscancer.org, MC), Oakland, CA, USA., Altschuler A; Division of Research, Department of Research and Evaluation, Kaiser Permanente Northern California, Oakland, CA, USA., Wiener L; Psychosocial Support and Research Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA., Kushi LH; Division of Research, Department of Research and Evaluation, Kaiser Permanente Northern California, Oakland, CA, USA., Chao CR; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA., Uno H; Division of Population Sciences, Department of Medical Oncology, and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
Jazyk:	angličtina
Zdroj:	Journal of the National Cancer Institute [J Natl Cancer Inst] 2024 Jul 01; Vol. 116 (7), pp. 1080-1086.
DOI:	10.1093/jnci/djae038
Abstrakt:	Background: Adolescents and young adults frequently receive chemotherapy near death. We know less about the use of targeted agents and immunotherapy or trends over time. Methods: We conducted a retrospective cohort study of 1836 adolescents and young adults with cancer who died between 2009 and 2019 after receiving care at 1 of 3 sites (Dana-Farber Cancer Institute, Kaiser Permanente Northern California, and Kaiser Permanente Southern California). We reviewed electronic health data and medical records to examine use of cancer-directed therapy in the last 90 days of life, including chemotherapy, targeted therapy, immunotherapy, and investigational drugs. Results: Over the study period, 35% of adolescents and young adults received chemotherapy in the last 90 days of life; 24% received targeted therapy, 7% immunotherapy, and 5% investigational drugs. Additionally, 56% received at least 1 form of systemic cancer-directed therapy in the last 90 days of life. After adjustment for patient sex, race, ethnicity, age, site of care, diagnosis, and years from diagnosis to death, the proportion of adolescents and young adults receiving targeted therapy (odds ratio [OR] = 1.05 per year of death, 95% confidence interval [CI] = 1.02 to 1.10; P = .006), immunotherapy (OR = 1.27, 95% CI = 1.18 to 1.38; P < .0001), and any cancer-directed therapy (OR = 1.04, 95% CI = 1.01 to 1.08; P = .01) in the last 90 days of life increased over time. Conclusions: More than half of adolescents and young adults receive cancer therapy in the last 90 days of life, and use of novel agents such as targeted therapy and immunotherapy is increasing over time. Although some adolescents and young adults may wish to continue cancer therapy while living with advanced disease, efforts are needed to ensure that use of cancer-directed therapy meets preferences of adolescents and young adults approaching death. (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
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