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ED Visits Part of Overuse of Care at End of Cancer Patients' Lives

CHAPEL HILL, NC – Despite the “Choosing Wisely” campaign to curb unnecessary care, younger patients with incurable cancers continue to receive aggressive end-of-life care through visits to EDs and other hospital-based treatment.

That’s according to a presentation at the recent 2016 American Society of Clinical Oncology Annual Meeting in Chicago. The University of North Carolina Lineberger Comprehensive Cancer Center-led study reviewed a national health claims analysis of cancer patients who were younger than age 65 and had metastatic disease.

"Cancer treatments have side effects, and as patients get closer to the end of life, aggressive treatments can also be less effective," said study co-author Aaron Falchook, MD, a resident in the UNC School of Medicine Department of Radiation Oncology. "In essence, what we're doing is we're giving patients side effects without giving them the benefits of the treatment, and that's really the fundamental problem with aggressive care at the very end of life."

Results revealed that nearly two-thirds were admitted as inpatients or visited the ED in the last 30 days of their lives, with nearly a third of them dying at the hospital. That’s despite ASCO recommendations in 2012 urging physicians to reduce aggressive end-of-life care.

"What this study shows is that recommendations by themselves may not be enough to change practice," added first author Ronald C. Chen, MD, MPH. "Along with published recommendations, more interventions targeted toward physician and patient education may be necessary to get actual changes in practice."

Reviewing claims data from the HealthCore Integrated Research Database for 28,731 patients younger than 65 and with metastatic lung, colorectal, breast, pancreatic, or prostate cancer, researchers focused on how often those patients received chemotherapy, radiation, an invasive procedure, went to the emergency room or were admitted to the hospital, or received intensive care in the last 30 days of their lives. The study team also looked at what percentage died in the hospital.

No matter the type of cancer, more than 70% of patients received one or more forms of aggressive care in their last month of life.

Rates of ED visits or hospital admission were among the most common types of aggressive care, with 62% of colorectal cancer patients and 65% of lung cancer patients using those services in their last 30 days.

Rates of chemotherapy at the end of life, meanwhile, ranged from 24% of prostate cancer patients to 33% patients with breast cancer.

“There is substantial overuse of aggressive end-of-life care among younger patients with incurable cancers,” study authors concluded. “Aggressive care did not decrease following the 2012 ASCO Choosing Wisely recommendations.”

"Overuse of aggressive care at the very end of life for a cancer patient can translate to increased burden on patients and their families," Falchook added in a UNC press release. "If these treatments are making patients sick, and if patients continue to go to the hospital, this can reduce their ability to really spend time with their loved ones at the end of life, and to get the most time out of the life that they do have left."