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Head and Neck Surgery

End-of-Life Care in Patients With Recurrent p16+ OPSCC

Monday, October 2, 2023
8:48 AM - 8:54 AM East Coast USA Time
Location: 201AB

    Presenting Author(s)

  • DL

    Doreen W. Lam, BA

    Medical Student
    Perelman School of Medicine, University of Pennsylvania
    Philadelphia, PA, United States

    • Co-Author(s)

  • Thomas J. Truong, BS

    Medical student
    Perelman School of Medicine, University of Pennsylvania
    Frisco, TX, United States

  • SC

    Steven B. Cannady, MD

    Assistant Professor of Otorhinolaryngology: Head and Neck Surgery
    Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
    Philadelphia, PA, United States

    • Senior Author(s)

  • RB

    Robert M. Brody, MD

    Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania, USA

Disclosure(s):
Doreen W. Lam, BA: No relevant relationships to disclose.
Introduction: While p16-positive oropharyngeal squamous cell carcinoma (p16+ OPSCC) has favorable prognosis, recurrence is observed in up to 17% of patients within 3 years. Despite the importance of conversations related to goals of care and advanced directives, there remains sparse literature on end of life (EOL) care practices. Here, we summarize EOL care patterns in patients with refractory disease.

Methods: A retrospective review was performed on p16+ OPSCC patients treated with primary transoral robotic surgery (TORS) between June 2010 and July 2021 who were actively followed at our institution in the 6 months preceding death. Demographics and treatment details were abstracted via chart review. Analysis was performed in RStudio.

Results: 46 patients met inclusion criteria (average age at death = 68 years). 48% had OPSCC recurrence (6 locoregional, 11 distant metastases, 5 locoregional and distant), 4.3% were considered cured after 5 years of surveillance with no evidence of disease and 1% were undergoing primary treatment at the time of death. 50% patients died of causes unrelated to OPSCC.

Of the 23 who died of OPSCC progression, median time between recurrence diagnosis and death was 11 months (IQR = 6.5 – 25). 22% received palliative therapy in their last 2 weeks, and 48% were on supportive measures (2 Dobhoff, 9 PEG tube, 23 tracheostomy, 3 intubated).

78% were admitted at least once in the last 6 months of life, 43% were admitted in the last 30 days and 13% died in hospital. 61% were referred to palliative care with first consult a median of 10 days before death (IQR = 6-15). 57% enrolled in hospice care with median of 18 days duration (IQR: 5-93).

74% had documented goals of care, which was significantly correlated with palliative care consult (p < 0.001) and home hospice (p < 0.035). While 63% had advanced directives updated a median of 3.3 months before death, 22% did not have documentation.

Conclusions: While goals of care discussions are strongly correlated with palliative care and home hospice, opportunities remain to optimize EOL care with earlier advance care planning and regular documentation of advanced directive preferences.