Many patients with cancer receive unnecessary imaging or chemotherapy in the last month of life, according to an article published in the Journal of Oncology Practice.1
Previous study indicates that patients who are not hospitalized and who do not receive aggressive treatment in their final weeks have a higher quality of life. Clinical guidelines recommend, among terminally ill patients likely to die within a month, that focus be on patient and symptom management rather than disease treatment.
Using the Western Washington Surveillance, Epidemiology, and End Results Program (SEER) registry, researchers identified 80,377 patients older than 18 years who were diagnosed with cancer between 2007 and 2015; 6568 patients were included in this study.
All included patients were enrolled in a commercial insurance program, made at least 1 insurance claim in their last 90 days of life, had an invasive solid tumor, and died within the study period.
Forty-six percent of patients were diagnosed with metastatic disease, which was most likely among patients with lung cancer. Half the patients were female and 61% were at least 65 years old.
Within their last month of life, 56.3% of patients were hospitalized, 18.5% received chemotherapy, 9.8% received radiation, and 48.6% underwent imaging.
Five hundred and twelve (7.8%) patients underwent chemotherapy within their last 2 weeks of life.
The authors noted that the high rate of hospitalization and aggressive treatment may be a consequence of insurance “structure and incentives.”
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The authors concluded that “[research] to identify barriers to hospice use and supportive care in this population can inform interventions to ensure that patients do not have untreated pain and are provided services to maximize their quality of life.”
- McDermott CL, Fedorenko C, Kreizenbeck K, et al. End-of-life services among patients with cancer: evidence from cancer registry records linked with commercial health insurance claims. J Oncol Pract. 2017 Jul 19. doi: 10.1200/JOP. 2017.021683 [Epub ahead of print]