{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T10:13:29Z","timestamp":1772878409043,"version":"3.50.1"},"reference-count":24,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"10","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Oncology Practice"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:sec><jats:title>PURPOSE:<\/jats:title><jats:p> The introduction of immune checkpoint inhibitors and targeted therapies improved the overall survival of patients with advanced melanoma. It is not known how often these costly treatments with potential serious side effects are ineffectively applied in the last phase of life. This study aimed to investigate the start of a new systemic therapy within 45 and 90 days of death in Dutch patients with advanced melanoma. <\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p> We selected patients who were diagnosed with unresectable IIIC or stage IV melanoma, registered in the Dutch Melanoma Treatment Registry, and died between 2013 and 2019. Primary outcome was the probability of starting a new systemic therapy 45 and 90 days before death. Secondary outcomes were type of systemic therapy started, grade 3\/4 adverse events (AEs), and the total costs of systemic therapies. <\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p> Between 2013 and 2019, 3,797 patients with unresectable IIIC or stage IV melanoma were entered in the registry and died. The percentage of patients receiving a new systemic therapy within 45 and 90 days before death was significantly different between Dutch melanoma centers (varying from 6% to 23% and 20% to 46%, respectively). Thirteen percent of patients (n = 146) developed grade 3\/4 AEs in the last period before death. The majority of patients with an AE required hospital admission (n = 102, 69.6%). Mean total costs of systemic therapy per cohort year of the patients who received a new systemic therapy within 90 days before death were 2.3%-2.8% of the total costs spent on melanoma therapies. <\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION:<\/jats:title><jats:p> The minority of Dutch patients with metastatic melanoma started a new systemic therapy in the last phase of life. However, the percentages varied between Dutch melanoma centers. Financial impact of these therapies in the last phase of life is relatively small. <\/jats:p><\/jats:sec>","DOI":"10.1200\/op.22.00061","type":"journal-article","created":{"date-parts":[[2022,8,9]],"date-time":"2022-08-09T19:59:11Z","timestamp":1660075151000},"page":"e1611-e1620","update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":3,"title":["End-of-Life Use of Systemic Therapy in Patients With Advanced Melanoma: A Nationwide Cohort Study"],"prefix":"10.1200","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1334-2232","authenticated-orcid":false,"given":"Jesper","family":"van Breeschoten","sequence":"first","affiliation":[{"name":"Dutch Institute for Clinical Auditing, Leiden, the Netherlands"},{"name":"Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Cancer Center Amsterdam, Amsterdam, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0838-0349","authenticated-orcid":false,"given":"Rawa K.","family":"Ismail","sequence":"additional","affiliation":[{"name":"Dutch Institute for Clinical Auditing, Leiden, the Netherlands"},{"name":"Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6173-0662","authenticated-orcid":false,"given":"Michel W.J.M.","family":"Wouters","sequence":"additional","affiliation":[{"name":"Dutch Institute for Clinical Auditing, Leiden, the Netherlands"},{"name":"Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands"},{"name":"Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doranne L.","family":"Hilarius","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Rode Kruis Ziekenhuis, Beverwijk, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liesbeth C.","family":"de Wreede","sequence":"additional","affiliation":[{"name":"Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5884-7704","authenticated-orcid":false,"given":"John B.","family":"Haanen","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands"},{"name":"Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands"},{"name":"Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7945-5846","authenticated-orcid":false,"given":"Christian U.","family":"Blank","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands"},{"name":"Division of Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maureen J.B.","family":"Aarts","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, GROW School for Oncology and Developmental Biology. Maastricht University Medical Center, Maastricht, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franchette W.P.J.","family":"van den Berkmortel","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Zuyderland Medical Center Sittard, Sittard-Geleen, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan Willem B.","family":"de Groot","sequence":"additional","affiliation":[{"name":"Isala Oncology Center, Isala, Zwolle, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geke A.P.","family":"Hospers","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellen","family":"Kapiteijn","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Leiden University Medical Center, 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