Physicians are ignoring efforts by the American Society of Clinical Oncology (ASCO) to curb the costly and potentially harmful practice of treating cancer patients aggressively at the end of their lives, according to research presented at the ASCO annual meeting in Chicago.
The study was the first to examine aggressive end-of-life care in cancer patients younger than 65 years of age. It was also the first to investigate end-of-life cancer care since ASCO warned physicians in 2012 that such treatments may be more harmful than beneficial. Potential harms include cancer-directed procedures and therapies; emergency room and intensive care unit (ICU) admissions; and in-hospital deaths.
The new study evaluated the use of aggressive care within the last 30 days of life from before to after ASCO’s 2012 Choosing Wisely campaign aimed at reducing aggressive end-of-life care.
A research team led by Dr. Ronald Chen, a radiation oncologist at the University of North Carolina’s Lineberger Comprehensive Cancer Center, analyzed claims data from the HealthCore Integrated Research Database, which includes approximately 60 million individuals enrolled in Blue Cross and/or Blue Shield-licensed plans in 14 states. A total of 28,731 patients younger than 65 years of age who died between 2007 and 2014 and who had diagnoses for metastatic lung, colorectal, breast, pancreatic, or prostate cancers were included in the study.
The researchers found that 71% to 76% of patients across different cancers received aggressive care within the last 30 days of life, including 30% to 35% of patients who died in the hospital. The rates of aggressive care between early 2012 (before ASCO’s Choosing Wisely campaign) and 2014 were unchanged in patients with colorectal and breast cancers (71% and 74%, respectively), and were increased in lung cancer (76%), pancreatic cancer (74%), and prostate cancer (72%).
Aggressive care included chemotherapy after multiple earlier rounds of treatment have stopped working and being admitted to an ICU. Such interventions at the end of life “are widely recognized to be harmful,” Chen said.
That’s mainly because most cancer drugs have serious adverse effects, including heart failure, mouth sores, and constipation, and because a patient who has not responded to earlier treatments and is fading has almost no chance of benefitting from more.
The researchers concluded that “there is substantial overuse of aggressive end-of-life care among younger patients with incurable cancers.”