June 4, 2003
Study suggests more cancer patients receiving aggressive care at end-of-life
C. Earle, MD
A growing number of terminally ill cancer patients may be receiving aggressive treatment when they were near death, according to study that was presented at the annual meeting of the American Society of Clinical Oncology in Chicago on June 1.
Dana-Farber Cancer Institute researchers and their colleagues studied the records of 28,777 Medicare-eligible patients aged 65 and older who died within one year of being diagnosed with lung, breast, colorectal, and other gastrointestinal tumors. They found that between 1993 and 1996, the use of chemotherapy among these patients increased from 27.9 percent to 29.5 percent. The number of patients receiving chemotherapy within two weeks of dying grew from 13.8 percent to 18.5 percent.
The researchers also observed an increase in the number of these patients who, during their last month of life, were seen in the emergency room (8.3 percent in 1993 to 10.7 percent in 1996) or admitted to an intensive care unit (7.1 percent to 9.4 percent). However, they also found that fewer patients were dying in acute care hospitals (33.2 percent, down from 35.8 percent) and more were using hospice care (40.5 percent up from 31.6 percent).
"There are indications of increasing utilization of aggressive interventions in cancer patients who are near death," say Craig Earle, MD, of Dana-Farber. "Interestingly, the availability of hospice services and related medical resources may reduce the chance that a patient will receive aggressive treatment at the end-of life. The appropriate distribution of resources for end-of-life care may improve the quality of care for many terminally ill patients."
Dana-Farber Cancer Institute (www.dana-farber.org) is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States. It is a founding member of the Dana-Farber/Harvard Cancer Center (DF/HCC), a designated comprehensive cancer center by the National Cancer Institute.
