01 | End-of-life care in advanced melanoma and other skin cancers: a retrospective cohort from an Italian comprehensive cancer center

Michela De Mattia¹, Enrica Teresa Tanda³, Andrea Boutros², Virginia Delucchi⁵, Eva Blondeaux⁵, Agostina Lagodin D’Amato¹, Irene Giannubilo¹, Lucia Del Mastro^1|2, Paolo Pronzato³, Francesco Spagnolo^3|4, Claudia Bighin³ | ¹Dipartimento di Medicina Interna e Specialità Mediche, Università degli Studi di Genova; ²U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova; ³U.O. Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova; ⁴Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università di Genova, Genova; ⁵U.O. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.

Background: Despite improvements in overall survival (OS) with immune-checkpoint inhibitors (ICIs) and targeted therapies, many patients with advanced melanoma or non-melanoma skin cancer (NMSC) still experience disease progression (PD) and remain on systemic therapy during the EoL phase. Evidence on treatment patterns, healthcare utilization, and palliative care integration in the last weeks of life remains scarce.

Methods: We conducted a retrospective study including consecutive patients with advanced skin cancers treated in a single Italian center who died from PD between 2015 and 2021. Data from the last six months of life on systemic therapies, radiotherapy, hospitalizations, emergency department (ED) visits, specialist consults, palliative care, and place of death were analyzed. Descriptive statistics and logistic regression were applied to identify predictors of healthcare use.

Results: A total of 93 patients were included (melanoma n=84, CSCC n=7, MCC n=2). In the last six months, 88 (95%) received systemic therapy, mostly ICIs (n=66, 71%); among BRAF-mutant patients, 33 (72%), received BRAF/MEK inhibitors. At three months before death, 80 (86%) remained on active treatment. Imaging was frequent, with a median interval between the last CT and death of 48 days. Palliative care involvement was limited: 14 (15%) had an outpatient palliative care consult, while 59 (63%) received home-based palliative assistance. Hospitalizations occurred in 55 (59%), and 45 (48%) had ≥1 ED visit in the last six months. Home-based palliative care tended to reduce ED visits (OR 0.43; 95% CI 0.13–1.3; p=0.1). Place of death was home in 47 (51%), hospital in 32 (34%), and palliative care unit in 10 (11%).

Conclusions: Most patients with advanced cutaneous malignancies remained on systemic therapy until the last weeks of life, with high healthcare use and scarce integration of palliative care. These findings underline the importance of earlier and systematic palliative care, alongside pragmatic decision-making to reduce ED visits and optimize quality of life near the EoL phase.