Aggressive Cancer Care at End of Life Remains Persistent Despite Increased Palliative Care

A recent study shows that the increase in integrated palliative care does not appear to have altered aggressive cancer care at the end of life, presented at the 2017 ESMO conference (September 8-12, 2017; Madrid, Spain).

In recent years, there have been heightened efforts to increase palliative care for patients with cancer nearing the end of life and to eliminate aggressive, unnecessary care. However, research has yet to determine the effectiveness of such efforts.

D Martins Branco, MSc, King’s College, Cicely Saunders Institute (London, UK), and colleagues conducted a study to determine prevalence and recent time trends of aggressive cancer care at end of life in adult patients. Researchers analyzed data of 92,155 patients (mean age, 73 years) from the Hospital Morbidity Database (Portugal). The primary outcome of the study was a composite aggressive cancer care at end of life indicator that compiled the presence of 1-14 indicators in the final 30 days of life or the use of chemotherapy, immunotherapy, or biological agents in the final 14 days of life.

Researchers calculated the prevalence of individual and composite indicators, as well as evaluated time trends in metastatic disease and main primary cancers. Any change greater than 5% was deemed clinically meaningful.

Results of the study showed that composite aggressive cancer care at end of life stayed relatively unchanged over time. Despite statistically significant changes in some individual indicators, researchers reported that none of these changes were deemed clinically meaningful.

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The rate of aggressive cancer care at end of life was 71.1% (69.9% in patients with metastases and 72.6% in others, P < .001). Prevalence of aggressive cancer care at end of life reportedly varied by type of primary cancer, with 79.3% in blood cancers and 62.7% in breast cancer (P < .01).

Additionally, authors of the study noted the most common individual indicators of aggressive cancer care at end of life application: more than 14 days in the hospital (42.7%, compared with 42.3% in metastatic disease) and surgery (27.8%, compared with 26.4% in metastatic disease).

Authors of the study concluded that “A lack of integrated palliative care, even with growing resources in the time frame analyzed, suggest that these have not been enough to reduce aggressive cancer care at end of life.” Further knowledge of disease trajectories may help contribute towards reducing aggressive, unnecessary care, they suggest.—Zachary Bessette

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