Patients receiving anti-cancer treatment near end of life experience higher rates of hospitalization, ED and ICU use, and less utilization of hospice

Patients who receive systemic anti-cancer treatment near end of life are more likely to be hospitalized, go to the intensive care unit or emergency department, and are less likely to utilize hospice care in the final 30 days of life, according to researchers at The University of Texas MD Anderson Cancer Center. This pattern of care was observed in patients who received all types of systemic anticancer therapy, including cytotoxic chemotherapy, immunotherapy and targeted therapies. The findings were published today in the Journal of Clinical Oncology.

"Nationwide, the overuse of systemic anti-cancer therapy at the end of life remains a persistent problem,” said corresponding author Kerin Adelson, M.D., chief quality and value officer at MD Anderson. “This study shows that such aggressive care causes real harm to patients in their final days as well as their families, often leading to medicalized deaths marked by unnecessary hospitalizations, ICU stays, emergency visits, and dying in unfamiliar settings away from home and loved ones."

The use of cancer treatment at end of life is associated with lower quality of life.

Researchers analyzed National Cancer Institute Surveillance, Epidemiology and End Results (SEER) Medicare data from over 315,000 adults aged 66 and up with various cancers who died between 2015 and 2020. They found that patients who received systemic cancer treatment in the last 30 days of life were three times more likely to visit the emergency room, 2.6 times more likely to be hospitalized and 1.8 times more likely to end up in the intensive care unit. In addition, these patients were twice as likely to die in the hospital, and many did not utilize hospice care.

According to Adelson, this data can lead to important policy considerations and help steer informed decisions for care guidelines and efforts to reduce excessive treatment use near the end of life. MD Anderson has made significant progress in reducing the overutilization of chemotherapy for this patient population through structural and practice changes. A key element of this work is partnering with patients and their families to have important conversations regarding prognosis and wishes for end-of-life care, Adelson explained.

For a full list of collaborating authors, disclosures and research funding support, read the full paper at Journal of Clinical Oncology.