Acute EOL Care Increased in Patients With Advanced Cancer

TOPLINE:

Among Medicare beneficiaries with advanced cancer, 45% had more than one acute care visit, in-hospital mortality, late receipt of systemic therapy, or hospice entry in the last 30 days of life.

METHODOLOGY:

• Historical evidence has shown that patients with advanced cancer often receive potentially aggressive care at EoL, including late initiation of systemic therapies and acute care use.
• Clinicians and professional societies have dedicated considerable efforts to improve EoL care quality in oncology over the past decade, including new quality measures and guidelines. The Centers for Medicare & Medicaid Services began reimbursing advanced care planning conversations in 2016 to promote high-quality, patient-centered EoL care.
• A retrospective cohort study analyzed 33,744 fee-for-service Medicare decedents aged ≥ 66 years with distant-stage breast, prostate, pancreatic, or lung cancers who died between 2014 and 2019.
• Analysis included monthly use of acute care, systemic therapy, and supportive care (palliative and hospice care and advanced care planning) in the last 6 months of life.
• Researchers evaluated claims-based indicators of potentially aggressive care in the last 30 days of life, including multiple acute care visits, in-hospital mortality, late systemic therapy, or hospice entry.

TAKEAWAY:

• From 6 months before death to month of death, acute care visits increased from 14.0 to 46.2 per 100 person-months, while hospice use rose from 6.6 to 73.5 per 100 person-months.
• Palliative care utilization showed an increase from 2.6 to 26.1 per 100 person-months, and advanced care planning rose from 1.7 to 12.8 per 100 person-months.
• Patients with prostate and pancreatic cancer showed lower probability of receiving potentially aggressive care than non–small cell lung cancer patients (percentage points, −4.68; 95% CI, −7.17 to −2.19; P P
• Use of palliative care increased over time, from 21% in 2014 to 35% in 2019, with older, non-Hispanic White patients and those with longer survival duration less likely to receive any palliative care.

IN PRACTICE:

“To make meaningful improvements in the quality of EOL care, a multifaceted approach that addresses patient, physician, and system-level factors associated with persistent patterns of potentially aggressive care will be required,” wrote the authors of the study.

SOURCE:

The study was led by Youngmin Kwon, PhD, Department of Health Policy, Vanderbilt University Medical Center in Nashville. It was published online on February 21 in JAMA Health Forum.

LIMITATIONS:

According to the authors, the data lacked several important determinants of EoL care, including patient preferences, symptom burden, functional status, and detailed characteristics of care settings. The claims-based measures of potentially aggressive care may not account for the appropriateness of care in specific clinical contexts. The sample was limited to only five cancer types, though these cancers contribute to more than 50% of all cancer deaths. Additionally, the study excluded Medicare Advantage beneficiaries whose claims data were unavailable.

DISCLOSURES:

Youngmin Kwon, PhD, reported receiving grants from the Agency for Healthcare Research and Quality outside the submitted work. The collection of cancer incidence data was supported by the California Department of Public Health, Centers for Disease Control and Prevention’s National Program of Cancer Registries, and the National Cancer Institute’s Surveillance, Epidemiology and End Results Program. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.