End-of-Life Cancer Therapy Increases Acute Care and Lowers Hospice

In this study, researchers investigated the impact of systemic anticancer therapy (SACT) on healthcare usage and hospice care among older adults near the end of life. They sought to understand how different types of cancer treatments, such as chemotherapy, immunotherapy, and targeted therapy, affect the quality of end-of-life care.

Understanding the effects of end-of-life cancer treatments is important for improving patient care. While newer cancer treatments are often seen as less harmful, their impact on healthcare usage and hospice care remains unclear. This research is important for healthcare providers, patients, and families to make informed decisions about cancer care in the final stages of life, potentially leading to better quality of life and reduced healthcare costs.

The researchers used data from the SEER-Medicare database, among patients aged 66 and older with various types of cancer who died between 2015 and 2020. They analyzed healthcare usage in the last 30 days of life, including emergency room visits, hospitalizations, intensive care unit admissions, and hospice use. They examined the effects of different types of SACT, adjusting for factors including age, sex, race, and cancer type.

Out of 315,089 patients, 7.6% received SACT within 30 days of death. The study found that any use of SACT was linked to increased emergency room visits, hospitalizations, and ICU admissions, and decreased hospice use. Patients receiving combination therapies had the highest healthcare usage and lowest hospice enrollment. These findings suggest that SACT near the end of life is associated with more intensive medical care and less hospice care.

The study highlights the need for careful consideration when administering cancer treatments near the end of life. It suggests that such treatments may lead to more care utilization rather than improving quality of life. The findings could influence healthcare guidelines and encourage discussions about the benefits and drawbacks of continuing cancer treatment in the final stages of life.

The authors suggest further research to better understand the relationship between end-of-life cancer treatments and healthcare usage. They emphasize the importance of improving prognostic tools to help healthcare providers make better-informed decisions about when to transition patients from active treatment to palliative care.

This research was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103885, CDC’s National Program of Cancer Registries under cooperative agreement 1NU58DP007156, and the National Cancer Institute’s SEER Program (contracts HHSN261201800032I, HHSN261201800015I, and HHSN261201800009I). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Yale University also provided funding and support for this research.