Systemic anticancer therapy during end of life in head and neck squamous cell carcinoma patients. A retrospective single center study

Purpose: Systemic anticancer treatments (SACTs) are used in advanced cancer stages to control disease and improve survival. However, their use at the end of life (Eol) can lead to side effects. This study aims to assess the clinical implications of SACTs near the Eol in patients with recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). Methods: This is an observational retrospective study conducted at Fondazione IRCCS Istituto Nazionale dei Tumori di Milano. R/M HNSCC patients treated from 2016 to 2024 were included and classified based on the timing of their last SACT relative to death: within 30 days (Cohort 1), and more than 30 days before death (Cohort 2). Cohort 1 was further subdivided into treatments given 15–30 days (1a) or within 14 days (1b) before death. We assessed performance status, survival outcomes, time from last therapy administration to death, fatal acute adverse events, and palliative care referral rates. Results: One hundred fifty-five patients were evaluable for the analysis. Patients receiving last anticancer therapy within 30 days of death exhibited worse overall survival compared to those who received their last treatment earlier (HR = 0.69; 95% CI 0.48–1.00; p = 0.047). Fatal acute events occurred in 31% of cases, with respiratory failure and major bleeding as leading causes. Conclusion: SACTs within 30 days of death correlates with worse prognosis and more aggressive disease. Major bleeding may be treatment-related when administered within 14 days of death. These findings emphasize the need for careful patient selection and early palliative care integration.