BACKGROUND Adults with impaired performance status (PS) often receive immune checkpoint inhibitors (ICIs) for advanced non-small cell lung cancer (NSCLC) despite limited efficacy data and unknown effects on end-of-life care. METHODS This was a retrospective, single-site study of 237 patients with advanced NSCLC who initiated ICI treatment from 2015 to 2017. Cox regression was used to compare the overall survival (OS) of patients who had impaired PS (≥2) at the start of ICI treatment with those who had PS 0 or 1 using Cox regression. Logistic regression was conducted to analyze the association between ICI use in the last 30 days of life and the use of end-of-life health care. RESULTS The patient mean age at ICI initiation was 67 years (range, 37-91 years), and 35.4% of patients had PS ≥2. Most patients (80.8%) received ICI as second-line or later therapy. The median OS was 4.5 months in patients with PS ≥2 and 14.3 months in those with PS 0 or 1 (hazard ratio, 2.5; P < .0001). Among the patients who died (n = 184), 28.8% who had PS ≥2 received ICIs in their last 30 days of life compared with 10.8% of those who had PS 0 or 1 (P = .002). Receipt of ICI in the last 30 days of life was associated with decreased hospice referral (odds ratio, 0.29; P = .008) and increased in-hospital deaths (odds ratio, 6.8; P = .001), independent of PS. CONCLUSIONS Adults with advanced NSCLC and impaired PS experience significantly shorter survival after ICI treatment and receive ICIs near death more often than those with better PS. Receipt of an ICI near death was associated with lower hospice use and an increased risk of death in the hospital. These results underscore the need for high-quality communication about potential tradeoffs of ICIs, particularly among adults receiving ICIs as second-line or later therapy.

中文翻译：

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非小细胞肺癌接受免疫检查点抑制剂的成年人的生产状况和临终护理。

背景技术尽管疗效数据有限且对生命终结护理的影响尚不明确，但患有运动状态（PS）障碍的成年人通常仍会接受针对晚期非小细胞肺癌（NSCLC）的免疫检查点抑制剂（ICI）。方法这是一项回顾性，单点研究，研究对象为2015年至2017年开始接受ICI治疗的237例晚期NSCLC患者。采用Cox回归比较开始时PS受损（≥2）的患者的总生存（OS）。使用Cox回归对PS 0或1的患者进行ICI治疗的效果。进行逻辑回归分析以分析生命的最后30天使用ICI与生命周期结束的医疗保健之间的关联。结果ICI开始时的患者平均年龄为67岁（范围37-91岁），PS≥2的患者占35.4％。大多数患者（80。8％）接受ICI作为二线或以后的治疗。PS≥2的患者的中位OS为4.5个月，PS 0或1的患者的中位OS为14.3个月（危险比，2.5； P <.0001）。在死亡的患者中（n = 184），PS≥2的患者中有28.8％在其生命的最后30天接受了ICI，而PS 0或1的患者中有10.8％接受了ICI（P = .002）。生命的最后30天收到ICI与临终关诊转诊减少（赔率，0.29； P = .008）和院内死亡增加（赔率，6.8； P = .001）相关，与PS无关。结论患有晚期NSCLC和PS受损的成年人比接受PS更好的成年人经历ICI治疗后生存时间明显缩短，并且接近死亡的ICI发生频率更高。接近死亡的ICI的接收与临终关怀的使用减少和医院死亡风险增加有关。