Cancer-Directed Therapy in the Last Month of Life and Its Association With ICU Utilisation in a Tertiary Care Centre in India

Background: Use of cancer-directed therapies (CDT) near the end of life is an established indicator of quality in oncology care. However, evidence from low- and middle-income countries (LMICs), including India, remains limited. Objectives: To describe patterns of cancer-directed therapy use in the last month of life and to evaluate the association between palliative care referral and ICU utilisation. Methods: This retrospective cohort study included adult cancer patients who died in hospital between August 2020 and July 2023 and received at least one CDT within the LMOL. Data were extracted using a standardised proforma. The primary outcome was the pattern and timing of CDT use. Secondary outcomes included ICU utilisation, palliative care referral and documentation of end-of-life care processes. Associations between palliative care referral and ICU utilisation were evaluated using unadjusted odds ratios. Results: Among 4211 in-hospital deaths, 669 patients had cancer, of whom 384 received CDT in the LMOL and were included. Chemotherapy was the most common modality (58.3%). CDT was administered within 14, 7 and 3 days of death in 72.3%, 45.0% and 23.4% of patients, respectively. ICU admission occurred in 62.7%. Palliative care referral was documented in 76.8% of cases, though often late. Patients with a palliative care referral had significantly lower odds of ICU admission than those without referral (OR 0.07, 95% CI 0.03–0.18, p < 0.001). End-of-life care documentation was present in 40.6% of cases. Conclusions: High-intensity care near the end of life, including frequent CDT use and ICU admission, remains common in this LMIC setting. Palliative care referral was strongly associated with lower ICU utilisation, suggesting a potential association that warrants further investigation in prospective studies.