Clinical benefit from late lines of therapy offered to patients treated in a tertiary referral centre

Background Late lines of therapy (LL) offered to cancer patients (pts) are often characterized by scarce or doubtful clinical benefit and literature evidences about their use and their real impact on survival and quality of life are very few. ESMO-MCBS (ESMO Magnitude of Benefit Scale) is a tool that gives an evaluation of the magnitude of clinically meaningful benefit that can be expected from anti-tumour therapies. The aim of our study was to evaluate ESMO-MCBS of the treatments that were offered as a LL to pts in our centre and to perform an evaluation of the clinical assistance they received. Methods We calculated ESMO-MCBS of the therapies that were offered as LL to pts that were treated at our centre and whose death happened in the period from January 1st, 2017 to December 31st, 2018. We also evaluated these pts’rate of unplanned access to emergency room or hospitalizations and their access to supportive care and palliative care service in the last 90 days of their lives. Results 238 pts were included in the analysis. 12 (5.04%) pts received a LL with a high ESMO-MCBS (4 or 5), 16 (6.72%) a LL with an intermediate ESMO-MCBS, 77 (32.35%) a LL with a low ESMO-MCBS (1 or 2), and 133 (55.88%) a LL whose ESMO-MCBS could not be calculated because of lack of data from strong literature evidences (e.g. phase-3 trials) that are required for the scale. 79 pts (33.19%) had at least an unplanned access to emergency room or hospitalization during the last 90 days before death. 117 pts (49.16%) accessed at least once to our supportive and palliative care service in the same timeframe. Conclusions Our study confirmed that patients are often offered a LL whose clinical benefit is little, absent or unevaluable. Merely half of these pts are addressed to supportive/palliative care service whose clinical impact is high in this setting. On the one hand, we then strongly suggest integrating ESMO-MCBS as a clinical tool for the evaluation of possible LL offered to advanced-stage pts in order to prevent them from receiving therapies of poor clinical impact. On the other hand it becomes mandatory to offer these pts a timely access to valuable, more precocious supportive and palliative care, which can positively impact on their quality of life in the last months of their lives. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.