Investigators have found that nearly 50% of patients with advanced cancer may receive potentially aggressive treatment at the expense of supportive care, despite considerable efforts to improve the quality of end-of-life care in the United States, according to a recent study published by Kwon et al in JAMA Health Forum.
Background
“Even though clinicians and professional health-care organizations have recommended early integration of supportive and palliative care for all patients with advanced cancers, it remains underused,” stressed senior study author Robin Yabroff, PhD, MBA, Scientific Vice President of Health Services Research at the American Cancer Society. “High-quality patient-centered end-of-life care is especially important for maximizing remaining quality of life for this population, yet uptake of advanced care planning and palliative care was low and late hospice enrollment was common,” she added.
Study Methods
In the study, the investigators used data from the Surveillance, Epidemiology, and End Results program linked with Medicare data to characterize patterns of end-of-life care among 33,744 patients aged 66 years or older with fee-for-service Medicare health insurance coverage who were initially diagnosed with distant-stage breast cancer, prostate cancer, pancreatic cancer, or lung cancer and died between 2014 and 2019. They examined the monthly utilization of acute care, systemic therapy, and supportive care—including palliative and hospice care and advanced care planning—in the last 6 months of life. Additionally, the investigators used a claims-based indicator to assess potentially aggressive care in the last 30 days of life, defined as experiencing more than one acute care visit, in-hospital mortality, late receipt of systemic therapy, or hospice entry.
The investigators discovered that only about 25% of the patients diagnosed with advanced cancer received palliative care in the last 6 months of life, and those who did received this type of care predominantly in the month of death. Overall, 45% of decedents experienced any indicator of potentially aggressive care. There was an increase in the mean number of 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 from 2.6 to 26.1 per 100 person-months, and advanced care planning from 1.7 to 12.8 per 100 person-months over the last 6 months of life.
Conclusions
“This research highlights the need for interventions to improve quality of care for patients with advanced cancers, especially those helping to remove barriers to better access palliative care,” Dr. Yabroff underscored. “It also suggests the importance of clear, proactive communication between providers and patients and their families regarding advanced care planning to better guide end-of-life care efforts,” she concluded.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
