Chemotherapy within the last 30 days of life among patients with metastatic solid tumors

e16574 Background: Metastatic solid tumors (MST) are rarely curable. However, treatment options for MST (stage IV) are increasing. Thus, discussing realistic therapeutic goals is critical to planning appropriate end of life medical interventions. We analyzed chemotherapy use within 30 days prior to end of life, and DNR orders, among patients with solid tumors (ST) who died at our institution. Methods: We reviewed all adult patients (age>18 years) with a diagnosis of ST who died in hospital at M.D. Anderson Cancer Center from June, 2010 through March, 2011 (excluded: hematologic malignancies). Data on patients’ demographics, chemotherapy within last 30 days (excluded: hormones), inpatient DNR orders, and comorbidities were from the institution’s administrative databases. Statistical analyses were: chi-square test for association between variables; univariate and logistic regression for association of chemotherapy use with age, gender, ethnicity, comorbidities, years of disease diagnosis, and metastatic status; statistical significance is defined as P value < 0.05. Results: 357 ST patients died in hospital: median age 60 years; 41% female; 81% MST; 44% had lung, breast or colorectal cancer. Patients receiving chemotherapy within last 30 days of life: 29% with MST; 18% without metastases (p = 0.06). DNR orders: 90% with MST, versus 79% without metastases (p =0.01). By regression analyses, there were no significant factors for chemotherapy use during the last 30 days of life (age, gender, ethnicity, years from time of disease diagnosis, metastatic status, and co-morbid conditions, each p>0.05). Conclusions: Only a small portion of patients with MST received chemotherapy within the last 30 days of life, while most had DNR orders indicating an end of life discussion. We need to study further the relationship of early discussion of treatment goals to clinical outcomes and end of life planning.