Background Adolescents and young adults (AYAs) frequently receive chemotherapy near death. We know less about use of targeted agents and immunotherapy or trends over time. Methods We conducted a retrospective cohort study of 1,836 AYAs with cancer who died between 2009-2019 after receiving care at one of three sites (Dana-Farber Cancer Institute, Kaiser Permanente Northern California, and Kaiser Permanente Southern California). We reviewed electronic health data and medical records to examine use of cancer-directed therapy in the last 90 days of life, including chemotherapy, targeted therapy, immunotherapy, and investigational drugs. Results Over the study period, 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 one form of systemic cancer-directed therapy in the last 90 days of life. After adjustment for patient sex, race, ethnicity, age, site of care, diagnosis, and years from diagnosis to death, the proportion of AYAs receiving targeted therapy (odds ratio (OR) 1.05 per year of death, 95% confidence interval (CI) 1.02-1.10, P = .006), immunotherapy (OR 1.27, 95%CI 1.18-1.38, P<.0001), and any cancer-directed therapy (OR1.04, 95%CI 1.01-1.08, P=.01) in the last 90 days of life increased over time. Conclusions More than half of AYAs receive cancer therapy in the last 90 days of life, and use of novel agents such as targeted therapy and immunotherapy are increasing over time. 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.

中文翻译：

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在青少年和年轻人生命临终时使用癌症导向疗法

背景 青少年和年轻人 (AYA) 经常在濒临死亡时接受化疗。我们对靶向药物和免疫疗法的使用或随时间变化的趋势知之甚少。方法 我们对 2009 年至 2019 年间在三个地点之一（丹纳法伯癌症研究所、北加州凯撒医疗机构和南加州凯撒医疗机构）接受护理后死亡的 1,836 名患有癌症的 AYA 进行了回顾性队列研究。我们审查了电子健康数据和医疗记录，以检查生命最后 90 天内癌症定向治疗的使用情况，包括化疗、靶向治疗、免疫治疗和研究药物。结果 在研究期间，35% 的 AYA 在生命的最后 90 天内接受了化疗；24% 接受靶向治疗，7% 接受免疫治疗，5% 接受研究药物。56% 的人在生命的最后 90 天内至少接受过一种形式的系统性癌症定向治疗。调整患者性别、种族、民族、年龄、护理地点、诊断以及从诊断到死亡的年数后，接受靶向治疗的 AYA 比例（比值比 (OR) 每年死亡 1.05，95% 置信区间 (CI) ）1.02-1.10，P = .006），免疫疗法（OR 1.27，95％CI 1.18-1.38，P <.0001），以及任何癌症定向疗法（OR1.04，95％CI 1.01-1.08，P =。 01) 生命的最后 90 天随着时间的推移而增加。结论 超过一半的 AYA 在生命的最后 90 天内接受了癌症治疗，并且随着时间的推移，靶向治疗和免疫治疗等新型药物的使用正在增加。虽然一些 AYA 可能希望在患有晚期疾病的同时继续进行癌症治疗，但仍需要努力确保针对癌症的治疗的使用满足接近死亡的 AYA 的偏好。