Overview
The use of systemic anti-cancer therapy (SACT) near the end of life (EOL) is associated with adverse outcomes, including higher hospitalization rates, more ICU use, delayed hospice transition, lower quality of life, and increased costs. Quality metrics endorsed by ASCO and NQF focus on reducing chemotherapy within 14 days of death, but despite widespread adoption, national SACT rates within this timeframe have remained constant. Criticisms of EOL treatment metrics include the potential for misclassification and overlooking patients who potentially benefit from aggressive treatment.
To address this knowledge gap, researchers from Yale, MD Anderson, and Flatiron Health investigated whether practices labeled as “aggressive” in SACT use near the EOL demonstrated improved overall survival in patients with advanced/metastatic cancer.
Why this matters
The findings from this study challenge prevailing practices in EOL oncology care, examining the relationship between practices labeled as “aggressive” in SACT use near the EOL and outcomes in advanced or metastatic solid tumors. The research addresses concerns about the ASCO/NQF measure, suggesting potential oversights in patients benefiting from treatment beyond 14 days.
With a comprehensive analysis across tumor types and inclusion of various therapies, the study prompts a nuanced examination of the economic factors influencing treatment decisions, emphasizing the need to explore the intricate interplay between financial considerations, treatment choices, and patient outcomes in the evolving landscape of EOL oncology care.