Despite significant efforts to enhance end-of-life care in the United States, a recent retrospective study conducted by researchers from the American Cancer Society (ACS) has revealed that nearly half of patients with advanced cancer received aggressive medical interventions rather than supportive care near the end of their lives. The findings were published today in The Journal of the American Medical Association Health Forum.
Inspite of recommendations from clinicians and professional healthcare organizations for early integration of supportive and palliative care, these services remain underutilized among patients with advanced cancers. High-quality patient-centered end-of-life care is particularly crucial to maximize quality of life in this population; however, uptake rates for advanced care planning and palliative care are low, and late enrollment into hospice services is common.
“This research underscores the need for interventions aimed at improving the quality of care for patients with advanced cancers,” said Dr. Robin Yabroff, scientific vice president of health services research at ACS and senior author of the study. “It also highlights the importance of clear, proactive communication between healthcare providers and patients and their families regarding advanced care planning to guide end-of-life efforts more effectively.”
Researchers analyzed data from the Surveillance, Epidemiology, and End Results (SEER) program linked with Medicare records to identify patterns in end-of-life care. The study included 33,744 patients aged 66 or older who had fee-for-service Medicare coverage and were initially diagnosed with distant-stage breast, prostate, pancreatic, or lung cancers between 2014 and 2019. Monthly utilization of acute care services, systemic therapy, and supportive care—such as palliative and hospice care and advanced care planning—were examined in the last six months of life.
A claims-based indicator was used to assess potentially aggressive care during the final 30 days of life, defined by more than one acute care visit, in-hospital mortality, late receipt of systemic therapy, or entering hospice. The study results showed that only about a quarter of patients received any palliative care within their last six months and often initiated it close to death.
Overall, 45% of the decedents exhibited at least one indicator of potentially aggressive care in the final month. Over the course of the last six months, there was an increase in acute care visits (from 14.0 to 46.2 per 100 person-months), hospice use (from 6.6 to 73.9 per 100 person-months), palliative care utilization (from 2.6 to 26.1 per 100 person-months), and advanced care planning engagement (from 1.7 to 12.8 per 100 person-months).
Dr. Youngmin Kwon is the lead author of the study, with other ACS researchers contributing to the report including Kewei Sylvia Shi, Dr. Jingxuan Zhao, Dr. Qinjin Fan, Dr. Xuesong Han, and Dr. Zhiyuan Zheng.
