Many patients with incurable cancer are not receiving the care that could significantly ease their suffering at the end of life, according to a new study. The research indicates that nearly half of the patients with advanced cancer underwent aggressive cancer treatment within six months of their death, often at the expense of palliative and hospice care.
Only a quarter of patients received any form of palliative care. When such care was provided, it was often delivered in the final month of life, as detailed in the study results. Senior researcher Robin Yabroff, the scientific vice president of health services research at the American Cancer Society, emphasized the importance of early integration of supportive and palliative care for all patients with advanced cancers, despite its current underuse.
Yabroff stated, "High-quality patient-centered end-of-life care is especially important for maximizing the remaining quality of life for this population, yet the uptake of advanced care planning and palliative care remains low, and late hospice enrollment is common."
The study compared cancer surveillance data with Medicare data to assess end-of-life care for cancer patients in the U.S. It included nearly 34,000 Medicare patients aged 66 or older diagnosed with advanced breast, prostate, pancreatic, or lung cancers, who passed away between 2014 and 2019.
Overall, about a quarter of these patients received palliative care during the study period, with the annual percentage increasing from 21% in 2014 to 35% in 2019. Conversely, 45% of advanced cancer patients received aggressive cancer care, often involving visits to intensive care units.
Lung cancer patients were the most likely to receive aggressive care (47%), followed by breast and pancreatic cancer patients (41%), and prostate cancer patients (38%). However, the study also noted a growing trend towards palliative care and advanced care planning in the last six months of life.
Yabroff highlighted the need for interventions to improve the quality of care for patients with advanced cancers, particularly those that remove barriers to accessing palliative care. "This research underscores the importance of clear, proactive communication between providers, patients, and their families regarding advanced care planning to better guide end-of-life care efforts," she added.
Researchers noted that cutting-edge targeted therapies and immunotherapies for cancer might tempt patients and families to opt for aggressive treatments. "These therapies may foster a belief that metastatic cancer may be curable, leading to potentially aggressive care despite patient preferences for initiating end-of-life care," they wrote in the study.
The research concluded that the highest rate of potentially aggressive care was observed among patients with metastatic lung cancer, a disease area experiencing a significant increase in innovative treatments during the study period.
