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

100Background: Days spent with healthcare contact while pursuing cancer treatment (i.e., “time toxicity”) may be particularly relevant when life expectancy is most limited. Patients with metastatic castrate resistant prostate cancer (mCRPC) ultimately choose whether to pursue further cancer directed therapies or receive supportive care and reduce expected healthcare contact. We sought to define the evolution of time toxicity over the last year of life in patients with mCRPC. Methods: Contact days, defined as any day with healthcare contact outside the home, were retrospectively assessed and categorized (e.g., infusion, ER visit) in 96 patients at an academic cancer center. The primary objective was to compare contact days in the 90-day period between 12 and 9 months prior to date of death (“first quarter”) and the 90-day period prior to death (“last quarter”) using the Wilcoxon signed rank test. Additional exploratory analyses were performed evaluating the association between clinicodemographic variables and systemic treatments received. Results: There were higher median [IQR] total contact days in the last quarter (6 [2, 17]) compared to the first quarter (4 [3, 6], p < 0.01), driven by ER visits and hospitalizations. Compared to patients off treatment/supportive care (4 [3, 4]) in the first quarter, chemotherapy (5 [4, 6], p = 0.02) and radiotherapeutics (5 [4, 9], p = 0.03) were associated with greater contact days, but androgen signaling inhibitors were not (3 [2, 5], p = 0.20). However, there were no significant differences in contact days between any treatment vs non-treatment in the last quarter. Non-White patients (n = 27) and those without higher education (n = 30) had more contact days in the last quarter (9 [2, 19], p < 0.01 for both). Patients who enrolled on hospice 7 days (n = 11) or 30 days (n = 39) before date of death had more contact days in the last quarter than those with earlier enrollment (23 [7, 28], p < 0.01; 13 [4, 24], p < 0.01 respectively). Conclusions: Healthcare contact was higher in the last 3 months of life due to increased number of days with inpatient level of care. Further studies to define healthcare exposure and time toxicity of mCRPC treatments are warranted to inform patient expectations towards the end-of-life.