Devenir des patients atteints de cancer métastatique hospitalisés dès le diagnostic

Real-world outcomes of metastatic cancer patients hospitalized at initial diagnosis: ONIRIS, a national study

Purpose: Little is known about metastatic cancer patients who are hospitalized at diagnosis because of impaired performance status and/or severe symptoms: this study aims to explore their prognosis and the effect of systemic anti-neoplastic treatment (SANT) initiation on their outcome.

Methods: A prospective study of adult inpatients with a newly diagnosed metastatic solid tumor registered in seven cancer-facilities in France. During a three-month follow-up, socio-demographic characteristics, response rate and duration of response for patients receiving SANT, length of hospital stay and survival were collected. Correlation with clinical prognostic and predictive factors were analyzed. We also assessed access to palliative care and end-of-life care aggressiveness criteria within this patient population.

Results: 107 patients were included from November 2021 to April 2022. Seventy-four (69%) underwent SANT. Median overall survival was 1.7 months for the entire cohort. Forty (37%) were alive at 3 months, including 39 patients that started SANT and 1 patient that received BSC only. Factors associated with the initiation of a SANT were young age (OR=0,94 [0,90; 0,98]), low Charlson Comorbidity Index (OR=0,56 [0,42; 0,73]), SANT initiated at patient’s or caregiver’s request (OR=0,07 [0,02; 0,17] and 0,17 [0,06; 0,42], respectively). Patients with biomarker-based targeted therapy and hormone therapy had a better outcome (8 out of 10 patients alive). PALLIA-10 score superior to 5 was a significant predictive factor for mortality (HR=3,24; p<0,001). The majority of oncologists (60%) and patients (60%) shared concordant treatment objectives, primarily palliative, aiming to increase survival (65 patients) or improve quality of life (13 patients). However, 15 patients (40%) misperceived the treatment objective as curative, with only 3 of them aligning with the oncologist's perspective. A high prevalence of aggressiveness criteria for end-of-life care, including repeated emergency department admissions, late initiation or continuation of anticancer treatments, and late palliative care engagement, was observed in the ONIRIS patient population. Many patients encountered a specialized palliative care team very late in their illness trajectory (23% of deceased patients within the last three days of their lives).

Conclusion: Metastatic cancer patients hospitalized at the time of diagnosis share a similar poor survival and a high exposure to agrressiveness of care near the end of life. The initiation of SANT does not always impact their outcome. Larger prospective studies with longer follow-up are needed to better assess the effect of SANT in this population.

Metastatic cancer patients hospitalized at initial diagnosis: a critical window for appropriate and shared decision-making - insights from the ONIRIS cohort

Purpose: Patients diagnosed with metastatic solid tumors during unplanned hospitalization represent a highly vulnerable population with limited survival. In this context, treatment decisions require clear communication and timely integration of palliative care (PC). We conducted an ancillary analysis of the ONIRIS cohort focusing on the patient’s trajectory, especially the concordance between treatment goals, PC involvement, and end-of-life (EOL) care intensity.

Methods: ONIRIS was a French prospective multicentric cohort including treatment-naive adults who were hospitalized at the time of metastatic solid tumor diagnosis. Baseline therapeutic intent and oncologists’ perceptions of patient understanding were recorded. PC interventions and predefined EOL indicators (systemic therapy within the last 30 and 15 days of life, emergency visits, hospitalizations, admission to an intensive care unit, and place of death) were extracted from electronic records over a 3-month follow-up period. 

Results: Among 107 patients, median overall survival was 51 days. Of 72 evaluable patients who received systemic treatment, 40% showed discordance between documented therapeutic intent and perceived patient’s goal, with frequent overestimation of curative potential. Half of patients received at least one PC intervention. Among 67 deceased patients, 27% received systemic therapy in the last 15 days of life and 39% in the last 30 days. 55% died in the same unit where they were initially admitted.

Conclusion: Hospitalization at the time of metastatic cancer diagnosis represents a critical window for shared and appropriate decision-making. In this high-risk population, discussions have to move beyond the sole question of treatment initiation and integrate the global trajectory of care.