Utility of 30-day mortality following systemic anti-cancer treatment as a quality indicator in advanced lung cancer

Background 30-day mortality after systemic anti-cancer therapy (SACT) has been suggested as a quality indicator primarily for measuring use of chemotherapy towards the end of life. Utility across different cancer types is unclear, especially when using immunotherapy and targeted therapies. Methods This retrospective study included patients with a diagnosis of lung cancer who received palliative-intent SACT at an Australian metropolitan cancer centre between 2015 and 2022. Using a prospectively maintained lung cancer database, patient, disease and treatment characteristics were evaluated against annual 30-day mortality rates following SACT. Results 1072 patients were identified. Annual 30-day mortality rate after palliative-intent SACT for lung cancer ranged between 9 and 15%, with significant variance between treatment types. Calculated rates of 30-day mortality are higher if longer reporting time periods are used. Patients who died within 30 days of SACT were more likely to have received targeted therapies or immunotherapy as their final line of treatment, have a poorer performance status at diagnosis, and have received multiple lines of treatment. Conclusions Our data support differential interpretation of 30-day mortality for quality assurance, especially with regard to lung cancer. Consistency in population and reporting time periods, and accounting for treatment type is crucial if 30-day mortality is to be utilised as cancer care performance quality indicator. Relevance to quality care is questionable in the lung cancer setting.