Despite ongoing efforts to enhance end-of-life care in the United States, a recent retrospective study by American Cancer Society (ACS) researchers has unveiled concerning findings: nearly half of patients with advanced cancer received potentially aggressive treatments instead of focusing on supportive care near their death. The results were published today in JAMA Health Forum.
Even though there have been recommendations from clinicians and healthcare organizations to incorporate supportive and palliative care early for all advanced cancer patients, its implementation remains limited. High-quality end-of-life care is crucial for improving the remaining quality of life for this group, but uptake of advance directives planning and palliative care has been low, with many only entering hospice late in their journey.
“Dr. Robin Yabroff, scientific vice president of health services research at ACS and lead author of the study explains that they analyzed data from SEER linked to Medicare records to examine patterns of end-of-life care among patients aged 66 or older with fee-for-service coverage who were initially diagnosed with distant-stage breast, prostate, pancreatic, or lung cancers. These individuals passed away between 2014 and 2019.
The researchers looked at monthly utilization rates for acute treatments, systemic therapy, and supportive care (including palliative and hospice care as well as advance directives) during the final six months of life. They also used a claims-based indicator to identify potentially aggressive end-of-life treatment in the last 30 days.
The findings were striking: only one-quarter received any form of palliative care within their final six months, often confined to just before death. Furthermore, 45% showed signs of receiving aggressive treatments during that time frame.
“We saw an increase over this period in acute visits from about 14 per patient-month to around 46; hospice usage went up significantly as well—from roughly seven patients per hundred person-months to almost seventy-four,” Dr. Yabroff added, highlighting the stark changes observed during this critical stage.
Dr. Robin Yabroff is joined in authoring the report by Dr. Youngmin Kwon and several other ACS researchers including Kewei Sylvia Shi, Jingxuan Zhao, Qinjin Fan, Xuesong Han, and Zhiyuan Zheng.
This research underscores the necessity for interventions aimed at enhancing care quality for advanced cancer patients. It also points to the critical role of clear communication between providers and patients regarding advance directives to ensure better end-of-life care planning.
