Less chemotherapy for equal survival: the impact of enhanced supportive care in hepatobiliary cancer


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Daniel Monnery1, Sinead Benson1, Helen Wong1, Anna Olsson-Brown1
1Clatterbridge Cancer Centre NHS Foundation Trust

Abstract

Background

Enhanced Supportive Care (ESC) can result in improved quality of life and survival. In 2018 we published early mixed-diagnosis data demonstrating trends towards improved survival and chemotherapy optimisation in ESC patients. Focusing on site-specific outcomes we reviewed the impact of ESC in patients with hepatobiliary (HPB) cancers. In this patient group there is no existing data comparing early palliative/supportive care plus chemotherapy versus chemotherapy alone. Survival was the primary endpoint and chemotherapy use a secondary outcome.

Method

A retrospective case-control method was implemented. Patients with HPB cancer who received ESC were compared to a control group who opted not to receive ESC. The control group was matched for tumour site, histology, age, performance status, surgery, site of metastases and chemotherapy regime. The investigators were blinded to group allocation. The anonymised survival data was analysed using Kaplan-Meier survival curves. Secondary outcomes were analysed using Mann-Whitney U Test. A significance value of <0.05 was accepted.

Results

A 101x101 matched case-control cohort was established. There was no significant difference in the median overall survival between the ESC group and the control group (16 month (IQR 20) vs 14 months (IQR 16), P=0.226).  ESC attenders received 31% fewer doses of chemotherapy compared to controls (n=1005 vs n=1460, p=<0.01). 

Conclusion

Patients with HPB cancer accessing ESC had equal survival to matched controls whilst receiving significantly less chemotherapy. This has the potential to have quality of life implications including avoidance of chemotherapy related side effects and complications including hospital admissions. There is also the strong possibility of an economic impact due to chemotherapy cost avoidance. 

Impact statement

Determining the quantitative impact of ESC models of care requires a broader assessment than survival alone and should include assessment of the characteristics of patients' cancer journeys.