End-of-life anticancer treatment - a nationwide registry-based study of trends in the use of chemo-, endocrine, immune-, and targeted therapies

Acta Oncol. 2021 Aug;60(8):961-967. doi: 10.1080/0284186X.2021.1890332. Epub 2021 Mar 2.


Background: Anticancer treatments near the end of a patient's life should generally be avoided, as it leaves the patient with no significant anticancer effect but increases the risk of severe side effects. We described the pattern of all end-of-life anticancer treatment in a population of Danish cancer patients.

Methods: Using the Danish national health registries, we identified all patients deceased due to cancer 2010-2015. Anticancer treatment registered in the last 30 days of life was categorized as end-of-life treatment. Predictors of such treatment were investigated using logistic regression models.

Results: We identified 42,277 patients (median age 70 years) of whom 16% received end-of-life anticancer treatment. This proportion did not change during the study period (p = .09). Chemotherapy alone was the most frequent treatment, accounting for 78% of all end-of-life treatment in 2010, decreasing to 71% in 2015. In contrast, end-of-life use of immunotherapy, targeted therapy and endocrine therapy increased during the study period. Breast cancer as index cancer was associated with the highest frequency of end-of-life treatment (23%), followed by malignant melanoma (21%), and prostate cancer (18%). Factors associated with lower odds for end-of-life treatment were female sex, older age, high burden of comorbidity, and being diagnosed >6 months prior to death.

Conclusions: We found a stable overall rate at 16% of patients receiving anticancer treatment within one month prior to death in this nationwide sample of cancer deaths. Further research is needed to assess whether this level of end-of-life treatment is justified or reflects inappropriate use.

Keywords: Epidemiology; cancer; end-of-life anticancer treatment; palliative.

MeSH terms

  • Aged
  • Death
  • Female
  • Humans
  • Male
  • Melanoma
  • Neoplasms / therapy*
  • Palliative Care
  • Registries
  • Terminal Care*