In a linked Surveillance, Epidemiology, and End Results (SEER)–Medicare analysis reported in the Journal of Clinical Oncology, Canavan et al found that receipt of systemic anticancer therapy (SACT) at the end of life (EOL) was associated with higher rates of EOL emergency department (ED) use, hospital admission, intensive care unit (ICU) admission, and in-hospital death among older patients with cancer.
Study Details
The study involved data from patients within SEER-Medicare (excluding those with Medicare Advantage) aged 66 years or older who were diagnosed with breast, colorectal, lung, prostate, bladder, cervical, kidney, liver, ovarian, pancreatic, or uterine cancer or melanoma between 2005 and 2019 and died between 2015 and 2020. Associations between SACT use in the last 30 days of life with health-care use during that period were analyzed.
Key Findings
Among 315,089 patients included in the analysis, 23,970 (7.6%) received SACT within 30 days of death. SACT consisted of cytotoxic therapy in 50.6% of patients, immunotherapy in 20.8%, targeted therapy in 18%, and combination therapies in 10.6%.
In an analysis adjusting for sociodemographic and cancer factors, compared with no SACT, any SACT use at the end of life was associated with increased ED use (odds ratio [OR] = 3.05, 95% confidence interval [CI] = 2.95–3.15), increased hospital admission (OR = 2.64, 95% CI = 2.56–2.72), increased ICU admission (OR = 1.78, 95% CI = 1.72–1.83), increased hospital death (OR = 2.02, 95% CI = 1.96–2.08), and reduced hospice use (OR = 0.51, 95% CI = 0.50–0.53).
Every subtype of SACT was individually associated with higher health-care use and lower hospice use (all P < .001).
The investigators concluded: “All subtypes of SACT use were associated with markers of worse-quality EOL care. These data can inform decisions for current care guidelines and efforts to reduce overutilization.”
Kerin B. Adelson, MD, of MD Anderson Cancer Center, Houston, is the corresponding author of the Journal of Clinical Oncology article.
Disclosure: The study was supported by the California Department of Public Health, National Cancer Institute, and others. For full disclosures of all study authors, visit ascopubs.org.
