Utility (or futility) of inpatient chemotherapy in patients with advanced solid organ cancers near end of life (FOCUS-EOL).

Abstract

289 Background: Chemotherapy near the end of life carries limited clinical benefit. We evaluated outcomes of patients with solid organ malignancies who received inpatient cytotoxic chemotherapy at a tertiary cancer center. Methods: We performed a retrospective study of adults with solid organ malignancies who received inpatient cytotoxic chemotherapy at The Ohio State University Comprehensive Cancer Center between April 1, 2024 and March 30, 2025. Patients with hematologic malignancies, planned chemotherapy admissions, clinical trial participation, and those receiving non-cytotoxic systemic therapies were excluded. Outcomes included death during index admission and mortality at prespecified time points following chemotherapy. Continuous variables were summarized using means with standard deviations or medians. Overall survival was evaluated using Cox proportional hazards regression with adjustment for age, sex, metastatic disease status, treatment intent, and prior lines of therapy, with results reported as hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Among 181 patients receiving inpatient chemotherapy, median age was 58 years (IQR 49–68), 54% were male, 85% had metastatic disease, and 87% received treatment with palliative intent. The most common malignancies were lung (27%), gastrointestinal (14%), breast (11%), and neuroendocrine cancers (9%), with symptom control being the leading indication for treatment (40%). 26 (14.4%) patients died during the index hospitalization. Mortality after inpatient chemotherapy was 7.7% at 7 days, 28.7% at 30 days, 43.6% at 60 days, 49.7% at 90 days, and 59.1% at 180 days, while 44% never received subsequent systemic therapy. ECOG 2 was more frequent among patients who died during hospitalization than survivors (52% vs 24%, p=0.025). In a predefined palliative cohort excluding small cell lung cancer, testicular cancer, sarcoma, and neuroendocrine malignancies (n=90), median survival was 57 days; 36% died within 30 days, 57% within 60 days, and 52% never received additional systemic treatment. Conclusions: Inpatient chemotherapy for advanced solid malignancies was associated with high early mortality and limited subsequent treatment, particularly in the palliative setting. Among patients receiving palliative chemotherapy excluding small cell lung cancer, testicular cancer, sarcoma, and neuroendocrine malignancies, median survival was only 57 days, with over half dying within 60 days, underscoring the need for careful patient selection and goals-of-care discussions.