Low Use of Chemotherapy in Last 14 Days of Life at MD Anderson Cancer Canter
A proposed metric of quality of cancer care is whether chemotherapy is administered in the last 14 days of life. In a retrospective study of patients at The University of Texas MD Anderson Cancer Center reported in JAMA Internal Medicine, Rodriguez et al found an overall rate of chemotherapy use in the last 14 days of life of 7.4%, including rates of 3.7% in patients with solid tumors and 24.8% in patients with hematologic malignant neoplasms.
Study Details
The study examined 7,399 patients with cancer aged ≥ 18 years who received care at MD Anderson Cancer Center and who died between December 2010 and May 2012. A total of 6,089 had solid tumors and 1,310 had hematologic malignancies. Death occurred as an inpatient for 11.1% of those with solid tumors and 44.6% of those with hematologic malignancies.
Proportions Receiving Chemotherapy
Among patients with solid tumors, proportions who received chemotherapy within 14 days of death were 3.8% for men and 3.6% for women; 4.6% for those aged < 65 and 2.6% for those aged ≥ 65 years; 3.5% for white, 4.0% for black, 4.1% for Hispanic, and 5.0% for other ethnicity; 14.8% for inpatients and 2.3% for those dying at other locations; 1.5% for those without metastasis/relapse and 4.4% for those with metastasis/relapse; and 4.0% for those without and 2.4% for those with comorbidities. As noted by the authors, the overall rate of 3.7% in patients with solid tumors is markedly lower than the 20% rate found in a previous study using Medicare claims data.
Among patients with hematologic malignancies, proportions who received chemotherapy within 14 days of death were 24.6% for men and 25.2% for women; 28.9% for those aged < 65 and 20.4% for those aged ≥ 65 years; 23.8% for white, 33.3% for black, 24.2% for Hispanic, and 24.5% for other ethnicity; 46.2% for inpatients and 7.6% for those dying at other locations; 20.1% for those without metastasis/relapse and 34.8% for those with metastasis/relapse; and 25.5% for those without and 22.6% for those with comorbidities.
Predictive Factors
Chemotherapy was administered more frequently to patients with hematologic malignancies vs those with solid tumors (24.8% vs 3.7%, P < .001) and to those who died in the hospital vs those who died elsewhere (29.3% vs 2.9%, P < .01). Multivariate analysis showed that patients who had solid tumors and metastatic disease or hematologic malignancies with or without relapse were significantly more likely to receive chemotherapy than patients with solid tumors without metastases (odds ratios [ORs] = 16.5, 33.1, and 2.5; P < .01). Chemotherapy use was significantly less common in patients aged ≥ 65 vs < 65 years (OR = 0.7, P < .01) and in patients with any comorbidities vs no comorbidities (OR = 0.8, P < .01). No significant differences in chemotherapy use were observed according to sex or ethnicity.
The investigators concluded, “We found overall that only a small proportion of our patients … had received chemotherapy within 14 days of death…. Communication with patients about realistic prognosis, treatment planning, and advanced care planning is a critical component across the continuum of oncology care…. We hope that analysis and reporting of observed practice patterns and disease outcomes will drive discussions between physicians and patients that address realistic concerns and the patient’s values around end-of-life care.”
Maria Alma Rodriguez, MD, of The University of Texas MD Anderson Cancer, is the corresponding author for the JAMA Internal Medicine article.
The authors reported no conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
