Time tO last ChemotherApy and death in ovaRian cancEr patients: TO CARE/MITO 42 study, a retrospective analysis of italian MITO centers

Giulia Scotto^1*Anna Galatà²Robert Fruscio^3,4Giulia Besana⁴Fabio Landoni^3,4Luca Sgro⁵Alessandra Testi⁵Fulvio Borella⁶Gennaro Cormio^7,8Mariangela Gianciotta^7,8Francesca Arezzo^7,9Brigida Anna Maiorano¹⁰Alessandra Baldoni¹¹Marinella Destefanis¹²Jole Ventriglia¹³Sandro Pignata¹³Rita Chiari¹⁴Maria Carmen Azzolina¹⁵Ivano Raimondo^16,17Margherita Turinetto²Valentina Tuninetti¹⁸Massimo Di Maio¹⁹Giorgio Valabrega¹⁸

• ¹Medical Oncology, ASL TO3 Ospedale degli Infermi, 10098 Rivoli, Torino, Italy, Rivoli, Italy
• ²Department of Oncology, University of Turin, 10124 Turin, Italy, Torino, Italy
• ³UO Gynecology, Fondazione IRCCS San Gerardo, Monza, Italy, Monza, Italy
• ⁴Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy, Milano, Italy
• ⁵Obstetrics and Gynaecology Unit, Umberto I Hospital, Department of Surgical Sciences, School of Medicine, University of Turin, Turin, Italy, Torino, Italy
• ⁶Gynecology and Obstetrics Unit 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy, Torino, Italy
• ⁷Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy, Bari, Italy
• ⁸Interdisciplinar Department of Medicine, University of Bari “Aldo Moro”, Bari, Italy, Bari, Italy
• ⁹Department of Precision and Regenerative Medicine - DiMePRe-J, University of Bari “Aldo Moro”, Bari, Italy, Bari, Italy
• ¹⁰Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy, Milano, Italy
• ¹¹Oncology and Hematology Department, Mirano AULSS3 Serenissima, 30035 Mirano, Italy, Mirano, Italy
• ¹²Dipartimento Chirurgico ASO S. Croce e Carle Cuneo, Cuneo, Italy
• ¹³Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS - Fondazione G. Pascale, Naples, Italy, Napoli, Italy
• ¹⁴UOC ONCOLOGIA AST PU, Pesaro, Italy
• ¹⁵AO Ordine Mauriziano, Torino, Italy, Torino, Italy
• ¹⁶School in Biomedical Sciences, University of Sassari, Sassari, Italy, Sassari, Italy
• ¹⁷Mater Olbia Hospital, Olbia, Italy, Olbia, Italy
• ¹⁸Department of Oncology, University of Turin, Medical Oncology, Ordine Mauriziano Hospital, Turin, Italy, Torino, Italy
• ¹⁹Department of Oncology, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy, Torino, Italy

Introduction: The European Society for Medical Oncology (ESMO) 2021 Guidelines contraindicate the administration of chemotherapy in the last month of patients' life. The main objective of this multicenter observational retrospective study was to calculate the time elapsed between the date of the last chemotherapy and the date of death of patients with ovarian cancer. The secondary objectives were to identify any factors associated with a greater probability of receiving chemotherapy in the end of life. Methods: Ovarian cancer patients operated between 2010 and 2020 in the participant Italian centers were enrolled. Only deceased patients whose date of death and date of last chemotherapy were known were included. Results: 603 women from 10 Italian centers were included. One patient out of four (25.7%) received chemotherapy in the last month of life. The median survival from the last chemotherapy was 66 days. Patients with a neutrophil/lymphocyte ratio ≥5, with high C-reactive protein at the start of the last line and patients dying in hospital compared to hospice/palliative care at home were more likely to undergo chemotherapy at the end of life (p<0.001, p=0.05 and p<0.001 respectively). Being treated in Northern Italy reduces the chance of receiving chemotherapy at the end of life in comparison with Center-South (p<0.001), as well as being enrolled in at least one clinical protocol (p=0.027). Discussion: The TO CARE/MITO 42 study is a snapshot of the Italian practice in which there are still disparities in the treatment of patients at the end of life. A prospective observational study could provide useful elements for early identification of patients who would not benefit from a further line.