Aims: This study aimed to identify the application of futile anti-cancer therapy at a single institution through analysis of patients receiving anti-cancer therapies within the last four weeks of life and the setting and timing of Acute Resuscitation Plan (ARP) discussions at this institution.

Methods: Oncology patients at the Gold Coast University Hospital who died after receiving cytotoxic chemotherapy and/or immunotherapy between January 2018 and December 2019 were analysed for timing of treatment to death and ARP completion including setting (inpatient vs outpatient vs emergency department (ED)) and time-to-death.

Results: Five hundred and twenty-six patients died after any treatment in the period analysed; 44.7% (235) were patients aged <65-years-old. 16.9% (89) died within 4 weeks of receiving treatment; 60% (53) were <65-years-old. 83.0% (437) patients received treatment >4 weeks before death; 23% (102) were <65-years-old. 90.0% (473) had documented ARPs, 44.3% of whom were <65. The majority (85.8%) were completed as in-patients, 4% in the ED and 10.1% as outpatients. Pertinently, 48.0% (227) of patients had ARPs completed within 4 weeks of death, and 52.0% (246) >4 weeks from death. In the outpatient setting, 62.9% (35) had their ARPs completed >4 weeks from dying, compared to 37.1% (13) <4 weeks of death. In those patients where an ARP discussion took place more than four weeks from death, 9.8% (24/246) received treatment within 4 weeks.

Conclusion: At our institution, a greater percentage of younger patients receive anti-cancer therapy versus older patients at end-of-life. Most patients had ARP discussions as in-patients; approximately half of all patients with ARPs died within 4 weeks of completed documentation; this appeared less likely when discussions were initiated in outpatients. Earlier advanced care planning may be a useful tool to initiate discussion regarding treatment goals, prevent futile treatments and are an on-going area for quality improvement.