Abstract
Introduction
This study aims to determine the 30-day mortality rate following intravenous systemic anticancer therapies (SACT) and to compare mortality rates between different therapeutic modalities, including immunotherapy, monoclonal antibodies, and chemotherapy.
Materials and methods
A retrospective analysis was conducted on cancer patients who received intravenous SACT between January 1, 2022, and December 31, 2022. Patient data, including demographics, cancer types, treatment details, and mortality outcomes, were collected from hospital records. The primary endpoint was 30-day mortality following the last dose of SACT.
Results
Among the 1,937 patients included, the overall 30-day mortality rate post-SACT was 7%. Significant factors affecting 30-day mortality included Eastern Cooperative Oncology Group (ECOG) performance status, body mass index (BMI), and smoking status. In Non-Stage 4 treated patients, a higher ECOG score was significantly associated with increased mortality. In Stage 4 treated patients, both a higher ECOG score and a lower BMI were independent predictors of increased mortality. Additionally, receiving Stage 4 treatment and being an active smoker significantly increased mortality risk in patients with gastrointestinal and breast cancers.
Conclusion
Monitoring 30-day mortality post-SACT is essential for improving oncological care quality. Identifying and addressing modifiable risk factors and carefully selecting patients for modern oncological treatments can help reduce mortality rates. Further prospective studies are warranted to explore the impact of immunotherapy on short-term mortality in diverse cancer populations.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12885-025-14513-1.
Introduction
Systemic anticancer treatments (SACT) are administered either alone or in combination with surgery or radiotherapy to enhance long-term survival. They may also be given to patients with advanced cancer to halt disease progression and alleviate symptoms [1]. Additionally, a crucial objective of treatment is to identify patients who will not benefit from SACT and thereby prevent unnecessary toxicity.
The treatments administered to cancer patients may reduce quality of life and contribute to fatigue [2]. Mortality within 30 days after the last dose of SACT is considered an indicator of the quality of oncological care. This period is deemed the most suitable timeframe for evaluating chemotherapy-related mortality rates. Mortality within the first 30 days following systemic anticancer therapy can serve as a valuable indicator of potentially preventable harm caused by treatment, though data on this metric are limited [3]. Understanding the patient characteristics associated with mortality within this timeframe can contribute to improving patient care quality and reducing financial toxicity. However, there is insufficient data in the literature regarding mortality rates following recent oncological advancements, such as immunotherapy or antibody-drug conjugates.
This study aimed to determine the mortality rate of patients receiving intravenous systemic anticancer therapy within the first 30 days after the last treatment dose. The secondary aim was to compare 30-day mortality rates between immunotherapy, monoclonal antibody treatments, and chemotherapy.
Materials and methods
A retrospective analysis was conducted to evaluate the 30-day mortality of cancer patients who received intravenous systemic anticancer therapy at Gazi University Faculty of Medicine Hospital between January 1, 2022, and December 31, 2022. Approval for this study was obtained from the local ethics committee (Gazi University Ethics Committee Date: January 9, 2023, Decision No: 19). Human Ethics and Consent to Participate declarations: not applicable. Clinical trial number: not applicable.
The objective was to evaluate mortality within the first 30 days following the last dose of intravenous anticancer therapy. Data collected included patient demographics, cancer types, systemic anticancer treatments received, treatment response status, date of death, and causes of death. This information was obtained from hospital information systems and patient records. Patients with stage 4 cancer receiving systemic anticancer treatment were classified as the Stage 4 treatment group, while those without metastases were classified as the Non-Stage 4 treatment group. We defined SACT as any intravenous cytotoxic chemotherapy, anticancer treatments such as monoclonal antibodies and immunotherapy. Patients who received non-intravenous treatments (such as tyrosine kinase inhibitors, oral chemotherapy, or hormone therapy) were excluded from the study. Additionally, patients who received concurrent radiotherapy during systemic anticancer therapy were excluded. This study was designed and reported in accordance with the CONSORT guidelines for randomized controlled trials.
The line of treatment (i.e., first-line versus later-line therapy) was determined using physician documentation and electronic medical records. Patients receiving their first intravenous SACT regimen were categorized as receiving first-line treatment, while those undergoing subsequent regimens were considered to have received later-line therapy.
Disease staging was based on documented evidence of metastatic disease in the clinical and radiological records at the time of SACT initiation. Due to inconsistencies in available TNM staging data, staging was simplified as Stage 4 (metastatic) versus Non-Stage 4 (non-metastatic).
A total of 128 patients were excluded from the final analysis due to receipt of non-intravenous systemic treatments (e.g., oral chemotherapy, tyrosine kinase inhibitors, or hormone therapy), concurrent radiotherapy, or missing treatment-related data.
To calculate the 30-day mortality rate following the last treatment dose, the date of the patient’s final intravenous chemotherapy session within the specified period was used as the starting point. Deaths occurring within the first 30 days after this treatment were identified through patient records and the hospital information system, and the 30-day mortality rate was then calculated based on this data.
Results
A total of 1937 patients were included in the study, with a 30-day mortality rate of 7% (n = 136) following the last dose of systemic anticancer therapy (SACT). Demographic data of these patients are detailed in Table 1.
Table 1.
Demographic data of all patients, including those who died and survived within 30 days last dose of systemic anticancer therapy (SACT)
| Characteristics | T All patients (n = 1937) | Survived (n = 1801) | Deceased (n = 136) |
|---|---|---|---|
| n(%) | n(%) | n(%) | |
| Gender | |||
| Male | 1007 (52) | 923 (51.2) | 84 (61.8) |
| Female | 930 (48) | 878 (48.8) | 52 (38.2) |
| Age | |||
| < 65 | 1202 (62.1) | 1127 (62.6) | 75 (55.1) |
| ≥ 65 | 735 (37.9) | 674 (37.4) | 61 (44.9) |
| ECOG | |||
| 0–1 | 1566 (80.8) | 1500 (83.3) | 66 (48.5) |
| ≥ 2 | 371 (19.2) | 301 (16.7) | 70 (51.5) |
| Systemic Therapy type | |||
| CT | 1514 (78.1) | 1404 (77.9) | 110 (80.9) |
| IO | 91 (4.7) | 78 (4.3) | 13 (9.6) |
| CT + IO | 13 (0.7) | 11 (0.7) | 2 (1.5) |
| CT + MAB | 241 (12.4) | 230 (12.8) | 11 (8.1) |
| MAB | 78 (4) | 78 (4.3) | - |
| Treatment Type | |||
| Curative | 846 (43.7) | 831 (46.1) | 15 (11) |
| Palliative | 1091 (56.3) | 970 (53.9) | 121 (89) |
| Smoking Status | |||
| Never | 962 (49.7) | 915 (50.8) | 47 (34.6) |
| Active Smoker | 438 (22.6) | 393 (21.8) | 45 (33.1) |
| Ex-Smoker | 537 (27.7) | 493 (27.4) | 44 (32.4) |
| BMI | |||
| < 18.5 | 81 (4.2) | 68 (3.2) | 13 (9.6) |
| 18.5–25 | 822 (42.4) | 749 (41.6) | 73 (53.7) |
| 25–30 | 566 (29.2) | 539 (29.9) | 27 (19.9) |
| > 30 | 468 (24.2) | 445 (24.7) | 23 (16.9) |
| Comorbidity | |||
| None | 673 (34.7) | 631 (35) | 42 (30.9) |
| Single | 1077 (55.6) | 1002 (55.6) | 75 (55.1) |
| Multiple | 187 (9.7) | 168 (9.3) | 19 (14) |
Categorical date are presented as number (percantage)
ECOG Eastern Cooperative Oncology Group, BMI Body Mass index, CT Chemotherapy, IO Immunotherapy, MAB Monoclonal Antibody
Comparison of factors affecting 30-day mortality after final SACT according to treatment types (Stage 4 or Non-Stage 4)
The results of the comparison of factors affecting 30-day mortality among 846 patients receiving Non-Stage 4 treatment are presented in Table 2. Fifteen of these patients died within 30 days after the last SACT, resulting in a 30-day mortality rate of 1.7%. The analysis shows a statistically significant difference in ECOG scores between patients who died and those who survived (p = 0.001). Specifically, the proportion of patients with an ECOG score ≥ 2 was significantly higher among those who died compared to those who survived (p = 0.001).
Table 2.
Comparison of factors affecting 30-day mortality after final SACT in patients receiving curative treatment
| Characteristics | All patients (n=846) | Survived (n=831) | Deceased (n=15) | P |
|---|---|---|---|---|
| n(%) | n(%) | n(%) | ||
| Gender | ||||
| Male | 359 (42.4) | 349 (42) | 10 (66.7) | 0.055 |
| Female | 487 (57.6) | 482 (58) | 5 (33.3) | |
| Age | ||||
| < 65 | 572 (67.6) | 564 (67.9) | 8 (53.3) | 0.230 |
| ≥ 65 | 274 (32.4) | 267 (32.1) | 7 (46.7) | |
| ECOG | ||||
| 0–1 | 773 (91.4) | 763 (91.8) | 10 (66.7) | 0.001 |
| ≥ 2 | 73 (8.6) | 68 (8.2) | 5 (33.3) | |
| Smoking Status | ||||
| Never | 477 (56.4) | 473 (56.9) | 4 (26.7) | 0.052 |
| Active Smoking | 174 (20.6) | 168 (20.2) | 6 (40) | |
| Ex-smoker | 195 (23) | 190 (22.9) | 5 (33.3) | |
| BMI | ||||
| < 18,5 | 28 (3.3) | 27 (3.2) | 1 (6.7) | 0.764 |
| 18,5–25 | 313 (37) | 309 (37.2) | 4 (26.7) | |
| 25–30 | 272 (32.2) | 267 (32.1) | 5 (33.3) | |
| > 30 | 233 (27.5) | 228 (27.4) | 5 (33.3) | |
| Comorbidity | ||||
| None | 310 (36.6) | 306 (36.8) | 4 (26.7) | 0.208 |
| Single | 468 (55.3) | 460 (55.4) | 8 (53.3) | |
| Multiple | 68 (8) | 65 (7.8) | 3 (20) | |
The comparison results of factors influencing 30-day mortality among the 1,091 patients receiving Stage 4 treatment are presented in Table 3. Of these patients, 121 (11%) died within the 30-day period. The analysis shows a statistically significant difference between those who died and those who survived in terms of ECOG score (p = 0.001), smoking status (p = 0.047), and Body Mass Index (BMI) (p = 0.001). Independent determinants of 30-day mortality after the last SACT in patients receiving Stage 4 treatment were found to be ECOG performance score and BMI. A performance score ≥ 2 was associated with a 3.6-fold increase in mortality (OR = 3.588 [95% CI 2.429–5.298], p < 0.001). Conversely, a higher BMI was associated with a 0.9-fold decrease in mortality (OR = 0.928 [95% CI 0.890–0.967], p < 0.001). A BMI < 25 was not found to be significantly associated with mortality in logistic regression analysis (p = 0.073).
Table 3.
Comparison of factors affecting 30-day mortality after final SACT in patients receiving palliative treatment
| Characteristics | All patients (n = 1091) | Survived (n = 970) |
Deceased (n = 121) |
P | |
|---|---|---|---|---|---|
| n(%) | n(%) | n(%) | |||
| Gender | |||||
| Male | 648 (59.4) | 574 (59.2) | 74 (61.2) | 0.676 | |
| Female | 443 (40.6) | 396 (40.8) | 47 (38.8) | ||
| Age | |||||
| < 65 | 630 (57.7) | 563 (58) | 67 (55.4) | 0.575 | |
| ≥ 65 | 461 (42.3) | 407 (42) | 54 (44.6) | ||
| ECOG | |||||
| 0–1 | 793 (72.7) | 737 (76) | 56 (46.3) | 0.001 | |
| ≥ 2 | 298 (27.3) | 233 (24) | 65 (53.7) | ||
| Smoking Status | |||||
| Never | 485 (44.5) | 442 (45.6) | 43(35.5) | 0.047 | |
| Active Smoking | 264(24.2) | 225 (23.2) | 39 (32.2) | ||
| Ex-smoker | 342 (31.3) | 303 (31.2) | 39 (32.2) | ||
| BMI | |||||
| < 18,5 | 53 (4.9) | 41 (4.2) | 12 (9.9) | 0.001 | |
| 18,5–25 | 509 (46.7) | 440 (45.4) | 69 (57) | ||
| 25–30 | 294 (26.9) | 272 (28) | 22 (18.1) | ||
| > 30 | 235 (21.5) | 217 (22.4) | 18 (14.9) | ||
| Comorbidity | |||||
| None | 363 (33.3) | 325 (33.5) | 38 (31.4) | 0.660 | |
| Single | 609 (55.8) | 542 (55.9) | 67 (55.4) | ||
| Multiple | 119 (10.9) | 103 (10.6) | 16 (13.2) | ||
Categorical data were evaluated in numbers (percentages) and compared using the chi-square or Fisher exact test
ECOG Eastern Cooperative Oncology Group, BMI Body Mass index
Comparison of factors influencing 30-day mortality after the last systemic anticancer treatment (SACT) in gastrointestinal system tumors
Supplementary Table 1 presents the comparison results of factors influencing 30-day mortality among 595 patients with gastrointestinal system (GIS) tumors included in the study. The 30-day mortality rate after the last SACT in patients with GIS tumors was found to be 8.9%. While the 30-day mortality rate after Non-Stage 4 SACT was 0.9%, this rate was 13.1% for Stage 4 treatments. The analysis reveals statistically significant differences between patients who died within 30 days and those who survived in terms of Eastern Cooperative Oncology Group (ECOG) performance score (p < 0.001), treatment type (p < 0.001), smoking status (p = 0.016), and Body Mass Index (BMI) (p = 0.014). ECOG performance score ≥ 2 was found to increase mortality risk by 4.4 times (OR = 4.402 [95% CI 2.361–8.208], p < 0.001). A higher BMI was associated with a 0.9 times decrease in mortality risk (OR = 0.897 [95% CI 0.834–0.965], p = 0.004). Receiving Stage 4 treatment was associated with an 11.1 times higher mortality rate (OR = 11.121 [95% CI 2.621–47.187], p = 0.001). Being an active smoker was found to increase mortality risk by 2.1 times (OR = 2.084 [95% CI 1.017–4.269], p = 0.045).
Comparison of factors influencing 30-day mortality after last systemic anticancer therapy (SACT) in breast cancer patients
The comparison results of factors influencing 30-day mortality among 369 patients diagnosed with breast cancer are presented in supplementary Table 2. The analysis indicates statistically significant differences between patients who died within 30 days and those who survived in terms of ECOG performance score (p < 0.001) and treatment type (p < 0.001). Independent determinants of 30-day mortality after the last systemic anticancer therapy (SACT) in breast cancer patients include ECOG performance score and receiving Stage 4 treatment. Palliative treatment is associated with a 5.6-fold increase in mortality risk (OR = 5.576 [95% CI 1.641–18.948], p = 0.006). Having an ECOG performance score ≥ 2 is associated with a 7.4-fold increase in mortality risk (OR = 7.366 [95% CI 1.474–36.807], p = 0.015).
Comparison of factors affecting 30-day mortality after final systemic anticancer therapy (SACT) in lung cancer patients
The comparison results of factors affecting 30-day mortality among 359 patients diagnosed with lung cancer are presented in supplementary Table 3. The 30-day mortality rate after the final SACT in patients diagnosed with lung cancer is 10.8%. This rate is 3.8% in patients receiving Non-Stage 4 treatment and 14.5% in those receiving Stage 4 treatment. According to the results, there is a statistically significant difference between patients who died and those who survived in terms of ECOG performance score (p < 0.001) and treatment type (p = 0.002).
Independent determinants of 30-day mortality after the final SACT in patients with lung cancer include ECOG performance score and receipt of Stage 4 treatment. Palliative treatment was found to increase mortality risk by 3.3 times (OR = 3.287 [95% CI 1.231–8.778], p = 0.018). Having a performance score ≥ 2 was associated with a 3.2 times higher mortality risk (OR = 3.218 [95% CI 1.606–6.448], p = 0.001).
In an expanded multivariable logistic regression analysis including comorbidity subtypes and treatment line, ECOG performance status and lower BMI remained independent predictors of 30-day mortality. Among the comorbidities analyzed, chronic kidney disease showed the strongest association with early mortality (OR = 2.46; 95% CI: 0.84–7.18; p = 0.099), although statistical significance was not reached. Patients receiving second- or later-line therapies had a modest but non-significant increase in mortality risk (OR = 1.43; p = 0.058).
Comparison of treatment types and 30-day post-last systemic anticancer therapy (SACT) mortality rates for all patients
The comparison results of systemic treatment types based on 30-day mortality for 1,937 patients included in the study are provided in Table 4. The analysis indicates a statistically significant difference in systemic treatment types between patients who died and those who survived (p = 0.002). The proportion of patients receiving chemotherapy (CT), immunotherapy (IO), and combined CT + IO treatment is higher among those who died, while the proportion of patients receiving CT and monoclonal antibody (MAB) combination treatment, as well as MAB treatment alone, is statistically significantly lower.
Table 4.
Comparison of treatment types and 30-Day mortality rates after final SACT in all patients
| Systemic Therapy type | All patients (n = 1937) | Survived (n = 1801) | Deceased (n = 136) | p |
|---|---|---|---|---|
| n(%) | n(%) | n(%) | ||
| CT | 1514 (78.1) | 1404 (77.9) | 110 (80.9) | 0.002 |
| IO | 91 (4.7) | 78 (4.3) | 13 (9.6) | |
| CT + IO | 13 (0.7) | 11 (0.7) | 2 (1.5) | |
| CT + MAB | 241 (12.4) | 230 (12.8) | 11 (8.1) | |
| MAB | 78 (4) | 78 (4.3) | - |
Categorical data were evaluated in numbers (percentages) and compared using the chi-square or Fisher exact test
ECOG Eastern Cooperative Oncology Group, BMI Body Mass index, CT Chemotherapy, IO Immunotherapy, MAB Monoclonal Antibody
The 30-day mortality rate among patients receiving chemotherapy is 7.2%. This rate is 14.2% in patients receiving only IO, 15.3% in patients receiving IO and CT in combination, and 4.5% in patients receiving CT and MAB in combination. No deaths were observed in patients receiving MAB treatment alone. Of the 136 patients who died within 30 days after treatment, 80.9% received systemic CT, 9.6% received IO, 1.5% received combined CT + IO, and 8.1% received CT + MAB treatment.
Table 5 presents the comparison results of factors affecting 30-day mortality among 104 patients receiving IO therapy. The analysis shows a statistically significant difference in terms of age (p = 0.017) between patients who died and those who survived. The 30-day mortality rate after receiving monotherapy or combination therapy with IO or CT was observed to be 14.4%. Among patients receiving IO therapy, the proportion of patients under 65 years of age is statistically significantly higher among those who experienced mortality compared to those who did not (p = 0.017). Being under the age of 65 was found to be 3.5 times more effective on mortality in patients receiving immunotherapy (HR = 3.500 [95% CI 0.945–12.958]). While immunotherapy-treated patients showed a numerically higher 30-day mortality rate, this result should be interpreted with caution due to the wide confidence intervals observed in subgroup analyses, reflecting limited statistical power.
Table 5.
Comparison of factors affecting 30-Day mortality after final SACT in patients receiving immunotherapy (IO monotherapy or in combination with Chemotherapy)
| Characteristics | All patients (n = 104) | Survived (n = 89) | Deceased (n = 15) |
p |
|---|---|---|---|---|
| n(%) | n(%) | n(%) | ||
| Gender | ||||
| Male | 80 (76.9) | 69 (77.5) | 11 (73.3) | 0.721 |
| Female | 24 (23.1) | 20 (22.5) | 4 (26.7) | |
| Age | ||||
| < 65 | 61 (58.7) | 48 (53.9) | 13 (86.7) | 0.017 |
| ≥ 65 | 43 (41.3) | 41 (46.1) | 2 (13.3) | |
| ECOG | ||||
| 0–1 | 73 (70.2) | 65 (73) | 8 (53.3) | 0.123 |
| ≥ 2 | 31 (29.8) | 24 (27) | 7 (46.7) | |
| Treatment type | ||||
| Curative | 11 (10.6) | 11 (12.4) | 0 (0) | 0.150 |
| Palliative | 93 (89.4) | 78 (87.6) | 15 (100) | |
| Smoking Status | ||||
| Never | 31 (29.8) | 26 (29.2) | 5(33.3) | 0.472 |
| Active smoking | 31 (29.8) | 25 (28.1) | 6 (40) | |
| Ex-smoker | 42 (40.4) | 38 (42.7) | 4 (26.7) | |
| BMI | ||||
| < 18.5 | 3 (2.9) | 2 (2.2) | 1 (6.7) | 0.787 |
| 18.5–25 | 58 (55.8) | 50 (56.2) | 8 (53.3) | |
| 25–30 | 33 (31.7) | 28 (31.5) | 5 (33.3) | |
| > 30 | 10 (9.6) | 9 (10.1) | 1 (61.7) | |
| Comorbidity | ||||
| None | 36 (37.6) | 29 (32.6) | 7 (46.7) | 0.252 |
| Single | 56 (53.8) | 48 (53.9) | 8 (53.3) | |
| Multiple | 12 (11.5) | 12 (13.5) | 0 (0) | |
| Treatmant line | ||||
| First line | 19 (18.3) | 18 (20.2) | 1 (6.7) | 0.209 |
| Multiple line | 85 (81.7) | 71 (79.8) | 14 (93.3) | |
Categorical data were evaluated in numbers (percentages) and compared using the chi-square or Fisher exact test
ECOG Eastern Cooperative Oncology Group, BMI Body Mass index
Discussion
Death within 30 days after the last systemic anticancer therapy (SACT) is an important indicator of the quality of cancer care. Identifying prognostic indicators of mortality within 30 days after SACT can significantly contribute to improving the quality of patient care and reducing financial toxicity [4–9]. In our study, higher mortality rates were observed in the first 30 days after the last dose of immunotherapy agents, which have recently significantly changed oncology practice, compared to chemotherapy. These findings underscore the importance of our study for further research in this area, as understanding these mortality rates can provide valuable insights for better treatment decisions and patient management strategies.
When previous literature studies were analysed for 30-day mortality rate after systemic anti-cancer treatment, it was observed between 1 and 12% depending on palliative-curative and cancer subtype [5, 10–13]. In our study, the 30-day mortality rate after SACT was found to be 7%. Wallington et al. found that the 30-day mortality rate after curative SACT for breast and lung cancers was < 1% in breast cancer and 3% in lung cancer. Again in this study, when patients who received curative treatment were compared with those with higher ECOG PS and those with better ECOG PS, the mortality rate after SACT was significantly higher in those with worse PS [11, 14–16]. In our study, 30-day mortality rate in all patients after curative SACT was similar to the literature. Among all patients who received curative SACT, the rate of ECOG score ≥ 2 in patients who died was statistically significantly higher than in patients who did not die. In a study by Zdenkowski et al., the 30-day post-treatment mortality rate of patients who received palliative SACT was found to be 12% [17]. Wallington et al. divided the patients receiving palliative treatment into breast and lung cancer and found that the 30-day mortality rate after palliative treatment was 8% in breast cancer and 10% in lung cancer [11]. During the palliative phase, the administration of treatment has been associated with increased mortality. Consequently, prior studies have recommended making patient-specific decisions regarding treatment and considering the early cessation of therapy [14, 18, 19]. When curative treatment, palliative treatment and total mortality were analysed, mortality rate was similar to the literature, but more than one factor may have caused the higher mortality rate compared to some studies. In our country, higher mortality rate may have been found due to factors such as different reimbursement conditions in treatment steps, ethnic origin differences, scarcity of palliative care centres and consequently ineffective use of palliative care, inclusion of all patients in the study without selecting specific cancer subtype. The higher mortality rate in patients with poor performance score may be explained by the fact that the underlying primary disease of the patients is in the advanced stage and the poor performance score may be related to the toxicity of the previous treatments and the side effects that may occur with the new treatment.
In a study conducted in England, it was observed that 30-day mortality rate was significantly higher in patients with lower body mass index compared with obese patients after Stage 4 SACT in patients with NSCLC [10]. In our country, Dizdar and colleagues investigated the factors affecting 30-day mortality after systemic anticancer treatment (SACT). They identified advanced age, male gender, BMI < 25 kg/m², and ECOG performance status ≥ 3 as independent factors associated with 30-day mortality. In our study, the proportion of patients with BMI values < 18.5 and 18.5–25 was statistically significantly higher in all patients who received Stage 4 treatment [20]. In addition, among patients who received SACT for GIS tumours, the proportion of those with BMI values < 18.5 and 18.5–25 was significantly higher in those who died compared to those who survived. The lower 30-day mortality rate in obese patients may be explained by the fact that patients with obesity were given lower doses of treatment according to body surface area. When all patients who received Stage 4 treatment and patients who received SACT for GIS tumours were analysed in our study, the proportion of patients who were active smokers was statistically significantly higher in patients who died compared to patients who died and survived, while the proportion of patients who had never smoked was statistically significantly lower. When the studies in the literature related with smoking and 30-day mortality after SACT were analysed, Y Ohe et al. found that smoking was not an independent risk factor in 30-day mortality after SACT in lung cancer [21]. Variations in driver mutations in lung cancer and the increased efficacy of immunotherapy in smokers may have contributed to this outcome. As there is no other data in the literature evaluating GIS tumours patients, it may be beneficial to confirm this result with further studies.
In our study, 30-day mortality rate after SACT was found to be 14.4% in the use of IO monotherapy and CT-IO combination. The 30-day mortality rate after SACT was found to be significantly higher in patients aged < 65 years who received immunotherapy monotherapy or IO and CT compared to patients aged > 65 years. In a study by Massarelli et al. the efficacy of subsequent treatments was low in patients who were given two or more SACTs and did not respond to treatment, and on the contrary, treatment-related toxicity was increased is known to increase [13]. In our study, the fact that the mortality rate was higher in patients who received IO may have been due to the fact that they could not receive the drug in the early stages of treatment due to the reimbursement conditions in our country, the fact that our patients who received IO were in Stage 4 care, and the fact that patients older than 65 years were included in the treatment less considering that they would be affected by the presence of additional comorbid diseases and treatment toxicity. In particular, the observed increase in 30-day mortality among patients receiving immunotherapy should be interpreted with caution due to wide confidence intervals in subgroup analyses, reflecting limited statistical power.
Retrospective single center study, evaluation of more than one cancer type and inclusion of patients at every stage are among the limitations of this study. Although the dates of death of the patients were obtained from the hospital system, the causes of death could not be accessed in the whole patient group. The exclusion of patients who received oral SACT is another limiting factor. On the other hand, the inclusion of approximately 2000 patients reduces bias and increases the objectivity of the study. However, the single-center design and the influence of local treatment access factors—such as national reimbursement policies and healthcare infrastructure—may limit the generalizability of these findings to other populations or healthcare settings. This limitation should be taken into account when interpreting our results in a broader context.
Conclusion
The 30-day mortality rate following systemic anticancer therapy is a crucial metric in oncology care. Addressing modifiable risk factors such as smoking and body mass index, and continuing treatment after modifying these factors, along with the accurate selection of modern oncology treatments and the early integration of Stage 4 care, can significantly enhance the quality of care. Additional prospective studies to evaluate the mortality rates of immunotherapy-monotherapy and immunotherapy-chemotherapy combinations are necessary to provide further clarity.
Supplementary Information
Additional file 1. Suppl. Table 1. Comparison of factors influencing 30-day mortality after the last systemic anticancer treatment (SACT) in gastrointestinal system Tumors. Suppl. Table 2. Comparison of factors influencing 30-day mortality after last systemic anticancer therapy (SACT) in breast cancer patients. Suppl. Table 3. Comparison of factors affecting 30-day mortality after final systemic anticancer therapy (SACT) in lung cancer patients.
Acknowledgements
We extend our gratitude to the staff of Gazi University Hospital, Department of Medical Oncology, for their valuable assistance in data collection and patient follow-up throughout the study.
Authors’ contributions
“T.E.C.,O.S. and O.A. wrote the main manuscript text and T.E.C. and O.S. prepared tables. All authors reviewed the manuscript.
Funding
This article has not received any financial support.
Data availability
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
Approval for this study was obtained from the local ethics committee (Gazi University Ethics Committee Date: January 9, 2023, Decision No: 19). This study did not require participant consent as it involved the analysis of publicly available data (or data that does not involve direct human interaction). No identifiable personal information was used, ensuring compliance with ethical standards.
Consent for publication
In publication author approval is avaliable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Additional file 1. Suppl. Table 1. Comparison of factors influencing 30-day mortality after the last systemic anticancer treatment (SACT) in gastrointestinal system Tumors. Suppl. Table 2. Comparison of factors influencing 30-day mortality after last systemic anticancer therapy (SACT) in breast cancer patients. Suppl. Table 3. Comparison of factors affecting 30-day mortality after final systemic anticancer therapy (SACT) in lung cancer patients.
Data Availability Statement
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.