Retrospective cohort study of use of cancer-directed therapy at the end of life among adolescents and young adults

Adolescents and young adults (AYAs, age 15-39 years) frequently receive chemotherapy near death. Less is known about the use of targeted agents and immunotherapy and about trends over time. A retrospective cohort study at Dana-Farber Cancer Institute, Kaiser Permanente Northern California, and Kaiser Permanente Southern California found that between 2009 and 2019, 35% of AYAs received chemotherapy in the last 90 days of life, 24% received targeted therapy, 7% immunotherapy, and 5% investigational drugs. Fifty-six percent received at least on form of systemic cancer-directed therapy in the last 90 days of life. After adjustment fo sex, age, race or ethnicity, site of care, diagnosis, and years from diagnosis to death, the proportion of AYAs receiving targeted therapy (per calender year OR 1.05; p=0.006), immunotherapy (1.27; p<0.0001), and any cancer-directed therapy (1.04; p=0.01) increased during the study period. The authors conclude that while some AYAs may wish to continue cancer therapy while living with advanced disease, efforts are needed to ensure that use of cancer-directed therapy meets preferences of AYAs approaching death.