Days spent with healthcare contact by patients with metastatic castrate resistant prostate cancer in the last year of life.

backgroundDays spent with healthcare contact during cancer treatment, or "time toxicity," may be particularly relevant to patients with end-stage malignancies, including metastatic castrate resistant prostate cancer (mCRPC), considering further cancer-directed therapies near the end-of-life. PATIENTS AND

methodsWe retrospectively assessed healthcare contact days (ie, days with healthcare contact outside the home) in the last 12 months of 96 patients with mCRPC at an academic cancer center. We compared contact days in the 90-day period between 12 and 9 months prior to death ("first quarter") and the 90-day period prior to death ("last quarter") using the Wilcoxon signed rank test, with additional univariate analyses focused on clinicodemographic variables, particularly systemic treatments.

resultsThere were higher median [IQR] total contact days in the last vs first quarter (6 [2,17] vs 4 [3,6], P < .01), driven by emergency room visits and hospitalizations. Compared to patients off treatment in the first quarter (4 [3,4]), chemotherapy (5 [4,6], P = .02) and radiotherapeutics (5 [4,9], P = .03) were associated with greater contact days, but not androgen signaling inhibitors (3 [2,5], P = .20). However, there were no differences in contact days by treatment in the last quarter. Patients enrolled in hospice experienced similar contact days between the last and first quarters (4 [2,15] vs 4 [3,7], P = .22).

conclusionPatients with mCRPC experienced increased healthcare contact in the last three months of life resulting from higher inpatient level of care, despite most enrolling in hospice. Future studies can further set expectations on time toxicity in end-stage mCRPC.