End-of-life care (ELC), or comfort care, describes a robust array of healthcare practices for patients who have stopped treatment to control their disease. A broad term encompassing physical, emotional, social, and spiritual support, ELC aims to alleviate pain and other disease-related symptoms to make the patient comfortable.
Cancer patients, particularly those with advanced cancers, often require ELC during the later stages of their disease. Because of this, efforts to improve the quality of ELC have grown over the past several years. However, whether these efforts have actually improved the quality of ELC remains to be determined. To address the progress made towards improving ELC, a team of researchers from various institutions evaluated the quality of care received by advanced cancer patients near the end of their life. The researchers published the results of the study in JAMA Health Forum.
The researchers performed a retrospective study using data from Surveillance, Epidemiology, and End Results (SEER) and Medicare databases. The study included 33,744 patients diagnosed with advanced breast, prostate, pancreatic, or lung cancers aged 65 or older who died between 2014 and 2019 with an average age of 76. The variables used for the analysis included monthly use of acute care, systemic therapy, and supportive care. The researchers considered palliative care, hospice care, and advanced care planning in the last six months of life as supportive care. In addition, the study investigates “aggressive care” in the last month of life, including more than one critical care visit, in-hospital mortality, late receipt of systemic therapy, or hospice entry.
The researchers calculated their findings using “person-months” by taking the number of patients divided by the number of days when patients were alive with a cancer diagnosis. The analysis revealed that advanced patients on Medicare experienced an increased number of acute care visits from six months before death until the month of death. Acute care visits increased from 14 to 46.2 per 100 person-months. In addition, 45% of patients evaluated experienced potentially aggressive care during the last month of life.
The study also found low participation in supportive care. Hospice enrollment (6.6 to 73.5 per 100 person-months), palliative care (2.6 to 26.2 per 100 person-months), and advanced care planning (1.7 to 12.8 per 100 person-months) also increased in the last six months of life. While Hospice care appeared to grow rapidly, most of the increase occurred in the last month of life.
The findings suggest that while advanced cancer patients on Medicare currently lack optimal ELC, there is significant potential for improvement. Many of these patients show patterns of receiving aggressive care while not receiving supportive care, suggesting that advanced cancer patients are likely to be over-treated and unlikely to receive timely ELC. This highlights the need for change and opportunities for improvement by targeting factors associated with aggressive care.
Source: JAMA Health Forum