Systemic treatment of cancer patients near end of life does not improve survival rates, according to a new study from researchers at Yale Cancer Center (YCC) and the University of Texas MD Anderson Cancer Center.
The study, which joins a growing body of research on end-of-life cancer treatment, was published May 16 in JAMA Oncology.
The results were based on examination of health records for 78,446 adult patients from 280 United States cancer clinics between 2015 and 2019. The study focused on patients with metastatic and advanced tumors in six common cancers: breast, colorectal, non-small cell lung (NSCLC), pancreas, kidney, and urothelial.
“We wanted to find out if oncologic treatment of very advanced tumors is associated with improved survival or if there are times when it’s futile to continue care and instead oncologists should shift focus to palliative and supportive care,” said Maureen Canavan, PhD, associate research scientist, first author of the study, and a YCC member.
The researchers combed through patient health records to learn whether those with advanced disease who received systemic treatments — such as immunotherapies, targeted therapies, or hormonal therapies — benefitted by having better survival rates. They did not, the researchers found.
The findings revealed no statistically significant survival benefit for patients treated at practices that used more systemic therapy compared with those that used less. This finding was observed across all cancer types studied.
“Since we don’t see an improved survival benefit, oncologists should revisit their goals of care conversations with patients, and this information in the study should be explained to patients,” said Canavan, who is also an epidemiologist at the Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center (COPPER). “We hope this information can help inform oncologists when they are deciding whether or not to continue treatment or transition patients who have metastatic disease to supportive care.”
The recent study builds on their previous 2022 work, also published in JAMA Oncology, that charted a gradual decline in chemotherapy use at end-of-life, but a corresponding uptick in use of the newer immunotherapy treatments. That study reported that the use of systemic treatment overall held steady at 17% in that time period (2015 to 2019).
The current study concluded, as have others, that oncologic treatment at end of life deserves re-evaluation. By identifying when additional therapy may be futile and improving communication skills around goals of care, oncologists may be able to better align treatment with patient preferences and improve end-of-life care.