Temporal association of palliative care consultation with the trajectory of broad-spectrum antibiotic use at the end of life in advanced cancer: a nationwide linked cohort study

Background:We examined the temporal association between palliative care (PC) consultation and broad-spectrum antibiotic use near end-of-life trajectory. Methods:This retrospective cohort study used nationwide linked data to assess adults with advanced cancer (2018-2022) who died by June 2023.Broad-spectrum antibiotic use was evaluated using propensity score-matched analyses of prescription proportion (odds ratios [OR]) and days of therapy (DOT) per 1000 patient-days (relative risks [RR]) across predefined end-of-life intervals within the last six months of life.Results: Among 12,012 matched patients, 4,102 received PC consultation.The PC group consistently showed lower prescription proportions than the non-PC group, from 6-3 months before death (58.3% vs 61.1%; OR, 0.89; 95% confidence interval [CI], 0.82-0.96) to the final week (13.8%vs 19.4%; OR, 0.66; 95% CI, 0.60-0.74).DOT differences emerged later, with significantly lower DOTs in the PC group during the final two weeks of life (113.7 vs 146.8;RR, 0.77; 95% CI, 0.61-0.99)and the final week (79.0 vs 116.0;RR, 0.68; 95% CI, 0.51-0.91). Conclusion:PC consultation was associated with reduced broad-spectrum antibiotic use during end-of-life, suggesting that integrating PC into stewardship frameworks may mitigate antimicrobial selection pressure in patients with advanced cancer.