Adoption of immune checkpoint inhibitors and patterns of care at the end of life

Our summary

Immune checkpoint inhibitors (ICIs) have transformed the oncology care landscape in recent years. However, as research continues to push the promise of ICIs forward, it remains unclear whether treatment at the end of life (EOL) has also changed in response. It’s been well established that aggressive cancer treatment at the EOL does not improve the patient’s quality of life nor prolong survival. In fact, those who receive systemic cancer treatment at the EOL may experience less patient-centered care due to a decrease in likelihood of receiving hospice and services and an increased risk of acute care use (such as emergency department visits, admissions to the intensive care unit and death in the hospital).

To further understand the association between FDA approvals of ICIs and treatment patterns at the EOL, researchers from Yale University, Stanford University, The Ohio State University, University of Pennsylvania and Flatiron Health examined treatment patterns at the EOL for patients with advanced melanoma, non-small cell lung cancer or microsatellite stable colon cancer.

Why this matters

Reducing the intensity of EOL care is a goal of quality-of-care initiatives. While immune checkpoints have become a major breakthrough across multiple tumor types, this RWE study may point to an unintended consequence of their therapeutic profile: favorable tolerability and high expectations for effectiveness. Namely, the tendency to use immunotherapy in EOL settings where less aggressive approaches may be preferable. RWE continues to be a source of insights into patterns of care, providing us with the tools to identify unexpected trends and address potentially detrimental practices.