Many patients with incurable cancer aren’t getting care that could ease their suffering at the end of life, a new study suggests.
Close to half of patients with advanced cancer received aggressive cancer treatment within six months of their death, researchers found — treatment that came at the expense of palliative and hospice care.
Only a quarter of patients received any palliative care. When such care did come, it usually was provided in the month they died, results show.
“Even though clinicians and professional healthcare organizations have recommended early integration of supportive and palliative care for all patients with advanced cancers, it remains underused,” senior researcher Robin Yabroff, scientific vice president of health services research at the American Cancer Society, said in a news release.
“High-quality patient-centered end-of-life care is especially important for maximizing remaining quality of life for this population, yet uptake of advanced care planning and palliative care was low and late hospice enrollment was common,” she added.
For the study, researchers compared cancer surveillance data with data from Medicare to build a picture of end-of-life care in the U.S. for cancer patients.
The study included nearly 34,000 Medicare patients 66 or older diagnosed with advanced breast, prostate, pancreatic or lung cancers who died between 2014 and 2019.
Overall, about a quarter of patients received palliative care during that period. The annual percentage steadily rose from 21% in 2014 to 35% in 2019, results show.
On the other hand, 45% of advanced cancer patients received aggressive cancer care, typically driven by visits to intensive care units, researchers found.
Lung cancer patients were most likely to receive aggressive care (47%), followed by breast and pancreatic cancer patients (41%) and prostate cancer patients (38%), results show.
However, the results also showed more people turning to palliative care and advanced care planning during the final six months of life.
“This research highlights the need for interventions to improve quality of care for patients with advanced cancers, especially those helping to remove barriers to better access palliative care,” Yabroff said.
“It also suggests the importance of clear, proactive communication between providers and patients and their families regarding advanced care planning to better guide end-of-life care efforts,” she added.
Cutting-edge targeted therapies and immunotherapies for cancer could be tempting patients and families to opt for aggressive treatment, researchers noted.
“These therapies may inculcate a belief that a metastatic cancer may be curable, leading to potentially aggressive care despite patient preferences for initiating end-of-life care,” researchers wrote in the study.
“Consistent with this hypothesis, we observed the highest rate of potentially aggressive care among patients with metastatic lung cancer, the disease area experiencing a disproportionate increase in the number of newly available innovative treatments during the study period,” the research team concluded.
The new study was published Feb. 21 in JAMA Health Forum.