According to a retrospective analysis published in the Journal of Clinical Oncology, the percentage of older patients with solid tumor cancers who receive chemotherapy during the last 2 weeks of life is declining over time.
Avoidance of chemotherapy administration within the last 14 days of life has been recognized as an important quality measure in oncology for over a decade. Nevertheless, the influence of this quality measure on practice patterns in oncology has not previously been evaluated. Furthermore, related issues such as use of targeted therapy near end of life, as well as the use of chemotherapy and targeted therapy within the last 6 months of life, have also not been explored previously.
In this study, the Surveillance Epidemiology and End Results (SEER)-Medicare claims database was interrogated for patient-, disease-, and treatment-related characteristics of patients older than 65 years with solid tumor cancers (ie, breast, colon, lung, prostate, and rectal) who died due to a cancer-related cause during the period covering 2007 through 2013. In addition, information regarding their clinicians was also accessed.
Of the 147,254 patients included in this analysis, the median age at death and median time from cancer diagnosis to death was 77 years and 1.3 years, respectively.
An important finding of this study was that from 2007 to 2013, only 5.8% of patients received chemotherapy during the last 2 weeks of life. Interestingly, this rate declined from 6.7% in 2007 to 5.5%, 5.6%, and 4.9% during 2010, 2012, and 2013, respectively.
This declining trend was also reflected in chemotherapy use during the periods covering 2 weeks to 1 month and 1 to 2 months prior to end of life despite the fact that these are not specific quality measures in oncology. However, a slight increase in chemotherapy use during the last 4 to 6 months of life was noted for this patient population over the study period.
Regarding overall targeted therapy use, these drugs were received by 1.2%, 3.6%, and 12.9% of patients within 14 days, 1 month, and 6 months prior to end of life, respectively. In addition, targeted therapy use was stable to “marginally increased” when patterns of medication use for 4 to 6 months prior to death were compared by type over time.
“Although the patterns of rising use of chemotherapy and targeted therapy [eg, during last 4 to 6 months prior to death] could actually appropriately reflect improving chemotherapy and targeted therapy regimens with less-toxic adverse effect profiles and/or more quality-of-life benefit, a major challenge still remains for defining value because of increasing cost burden of therapy and a widening number of effective targeted therapies,” the study authors noted.
Characteristics of patients more likely to receive chemotherapy in the last 2 weeks of life included younger age, being married, fewer comorbidities, higher stage of disease, worse performance status, higher median income, higher education level, and resident of an urban county. Characteristics of physicians more likely to prescribe chemotherapy to patients within 2 weeks of death included being the primary medical oncologist for the patient, and managing a higher patient volume.
In their concluding remarks, the study authors noted that these “results may inform current strategies to help to achieve high-value [end of life] oncology practice.”
Fang P, Jagsi R, He W, et al. Rising and falling trends in the use of chemotherapy and targeted therapy near the end of life in older patients with cancer [published online May 29, 2019]. J Clin Oncol. doi: 10.1200/JCO.18.02067