In a study reported in JAMA Oncology, Canavan et al found no differences in overall survival between oncology practices that were more vs less likely to provide chemotherapy within the last 2 weeks of life to patients with very advanced solid tumors.
As stated by the investigators, “ASCO and the National Quality Forum (NQF) have developed a cancer quality metric aimed at reducing systemic anticancer therapy administration at the end of life. This metric, NQF 0210 (patients receiving chemotherapy in the last 14 days of life), has been critiqued for focusing only on care for decedents and not including the broader population of patients who may benefit from treatment.”
Study Details
The study objective was to determine whether the overall population of patients with advanced/metastatic cancer receiving care at practices with higher rates of oncologic therapy distribution for very advanced disease experience longer survival. The study used data from Flatiron Health on patients with six common cancer types (breast cancer, colorectal cancer, non–small cell lung cancer [NSCLC], pancreatic cancer, renal cell carcinoma, and urothelial cancer) with advanced/metastatic disease who were treated at health-care practices from 2015 to 2019. Practices were stratified into quintiles based on retrospectively identified rates of NQF 0210 (low = lowest use; high = highest use).
Key Findings
The analysis included 78,446 patients from 144 U.S. practices. For the two most common cancers—NSCLC and colorectal cancer—practice-level NQF 0210 rates varied from 10.9% (quintile 1) to 32.3% (quintile 5) for patients with NSCLC (n = 34,201) and from 6.8% (quintile 1) to 28.4% (quintile 5) for those with colorectal cancer (n = 15,804). No significant differences in risk of death were observed for the fifth quintile vs first quintile for NSCLC (hazard ratio = 0.98, 95% confidence interval [CI] = 0.90–1.06) or colorectal cancer (HR = 0.96, 95% CI = 0.79–1.17).
For the fifth vs first quintile, the hazard ratio for death ranged from 0.74 (95% CI = 0.55–0.99) for renal cell carcinoma to 1.41 (95% CI = 0.98–2.02) for urothelial cancer. Hazard ratios were 1.17 (95% CI = 0.99–1.37) for pancreatic cancer and 1.28 (95% CI = 0.98–1.66) for breast cancer. None of the hazard ratio for any cancer type met the significance level of P = .008 determined by Bonferroni correction for multiple comparisons.
The investigators concluded, “In this cohort study, patients with metastatic or advanced cancer treated at practices with higher NQF 0210 rates did not have improved survival. Future efforts should focus on helping oncologists identify when additional therapy is futile, developing goals of care communication skills, and aligning payment incentives with improved end-of-life care.”
Kerin B. Adelson, MD, of The University of Texas MD Anderson Cancer Center, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was funded by Flatiron Health, an independent member of the Roche group. For full disclosures of the study authors, visit jamanetwork.com.
