According to a study published in JAMA Health Forum, many Medicare patients with advanced cancer receive potentially aggressive treatment at the expense of much-needed supportive care. The research analyzed records from 33,744 decedents aged 66 or older who passed away due to breast, prostate, pancreatic, or lung cancers.
The study found that claims data showed that nearly half (45%) of these patients experienced aggressive treatments such as multiple acute care visits days before death. In contrast, there was a low receipt of supportive end-of-life care like palliative and hospice services during the last six months of life. While hospice use skyrocketed to over 70% in the month leading up to death, more than one-sixth (16%) spent less than three days receiving such care.
Moreover, only around a quarter (25%) received advanced care planning and palliative support during their terminal stage. The researchers highlighted that even with increased awareness about aggressive treatment risks in the last decade, end-of-life care still tends to favor over-treatment.
Youngmin Kwon, Ph.D., from Vanderbilt University Medical Center’s Department of Health Policy, noted access variations among demographic groups. For instance, older patients, non-Hispanic whites, those with longer survival periods and residing in rural or low-socioeconomic areas were less likely to receive supportive care.
“Hospice is often considered the gold standard for managing end-of-life care needs,” Kwon emphasized. “However, the fact that a significant portion did not use hospice at all or only entered it within three days of death indicates that many missed out on its benefits.”
The study’s findings underscored the necessity for multi-faceted efforts to improve quality end-of-life care for cancer patients. Clear and honest communication between patients, caregivers, and healthcare providers regarding prognosis and advanced planning is crucial.
Additionally, policies increasing access to supportive services while ensuring an adequate palliative care workforce are essential to address structural barriers that hinder high-quality terminal-stage care.
