Thirty-day mortality after systemic anticancer treatment as a real-world, quality-of-care indicator: the Northland experience

Background: Systemic anticancer treatment (SACT) at the end of life is considered poor practice due to its futility and associated toxicities. Consequently, 30-day mortality after SACT is increasingly recognised as a potential real-world quality-of-care indicator in medical oncology. Aims: Whangarei Base Hospital (WBH) provides outpatient SACT treatment to all patients living in the Northland region of New Zealand. The goal of this study was to report our 30-day mortality after SACT and to contribute to the experience of its use in Australasia. Methods: In this retrospective study, the WBH electronic database was searched to identify all patients who had received SACT in WBH from 1 January 2012 to 31 December 2016. Patients who died within 30 days of their last treatment were short-listed. Records were reviewed identifying key demographic, disease, treatment and mortality data. Composite 30-day mortality index and that of each tumour stream were calculated. Key findings were described using descriptive statistics. Results: Over 5 years, 1103 patients received SACT in WBH, with 57 patients dying within 30 days of treatment, resulting in a composite 30-day mortality rate of 5.17%. One patient died receiving curative intent SACT. More deaths occurred in SACT-naive patients and during the first two cycles of therapy. Of the deaths, 28% was attributed to SACT, while 59.7% was attributed to cancer progression. Conclusion: Thirty-day mortality rates were comparable to studies from larger institutions. We demonstrated the feasibility of this index for auditing practice in smaller oncology units over a longer timeframe.