CHICAGO — Many patients aged 65 years or younger with metastatic cancer underwent aggressive treatments and invasive procedures or were admitted to the hospital as the end of life, according to an analysis of claims data presented at the ASCO Annual Meeting.
“The use of aggressive care did not decrease after ASCO's 2012 ‘Choosing Wisely’ recommendations,” Ronald C. Chen, MD, MPH, associate professor of radiation oncology and director of the cyberknife radiosurgery program at Lineberger Comprehensive Cancer of University of North Carolina in Chapel Hill, said at a press briefing. “Efforts are needed to improve end-of-life care for patients with terminal disease to ensure that care meets the goals and preferences of patients and their families.”
Aggressive medical care at the end of life — such as cancer-directed procedures and therapies, ED and ICU admissions, and in-hospital deaths — are acknowledged as harmful to patients with cancer.
The 2012 ASCO Choosing Wisely recommendations supported palliative care rather than cancer-directed treatment in patients with advanced solid tumors in patients unlikely to benefit from treatment. This included patients with a poor performance status, patients who did not benefit from prior interventions, patients ineligible for clinical trials, and patients for whom no evidence exists to support additional anticancer treatments.
Chen and colleagues evaluated the prevalence of aggressive care within the last 30 days of life among patients younger than 65 years treated before and after the Choosing Wisely recommendation.
Researchers analyzed data from HealthCore Integrated Research Database to identify 28,731 patients from 14 states in different regions of the country who died between 2007 and 2014. Patients had a diagnosis of metastatic breast (n = 5,855), colorectal (n = 5,207), lung (n = 12,764), pancreatic (n = 3,397) or prostate (n = 1,508) cancers.
In total, a range 71.2% to 75.9% of patients across all cancers analyzed received aggressive care within the final 30 days of life, and 30.3% to 35.4% of patients died in the hospital. Rates of any aggressive care use was highest of patients with lung cancer (75.9%).
The most common type of aggressive care in the last 30 days of life was hospital admission or ED visit (61.6% to 65.1% of patients). Further, 24.2% to 32.6% of patients received chemotherapy in the last 30 days of life, 25.3% to 31.1% underwent invasive procedures, 15.9% to 20.6% were admitted to the ICU, and 5.8% to 20.6% received radiation.
Only 14% to 18% of patients received hospice care.
In the 32 months following release of the Choosing Wisely recommendations, rates of aggressive care were unchanged in the colorectal and breast cohorts and higher in the lung, pancreatic and prostate cancer cohorts.
Limitations of the analysis include that researchers could not evaluate cause of death or reason for aggressive care in the 30 days preceding death.
“We are really bad at estimating a patient's life expectancy,” Chen said. “We [as oncologists] have a desire to help out patients, and we want to be able to offer them treatments as they approach end of life.” – by Nick Andrews
Chen R, et al. Abstract 10033. Presented at: ASCO Annual Meeting; June 3-7, 2016; Chicago.
Chen reports a consultant/advisory role with Medivation/Astellas and research funding from Accuray. Please see the abstract for a complete list of relevant financial disclosures.