Association Between Systemic Anticancer Therapy Administration Near the End of Life With Health Care and Hospice Utilization in Older Adults: A SEER Medicare Analysis of End-of-Life Care Quality
Menées respectivement à partir des données des registres américains des cancers portant sur 315 089 patients âgés de plus de 66 ans et décédés d'un cancer entre 2015 et 2020 et à partir des données d'un registre canadien des cancers portant sur 68 963 patients, ces deux études analysent l'association entre l'administration d'un traitement anticancéreux systémique, l'utilisation de soins de santé et les hospitalisations dans les 30 derniers jours de vie
Purpose: Use of cytotoxic chemotherapy at end-of-life (EOL) is associated with adverse quality of life, increased health care utilization, and lower hospice rates. Although EOL cytotoxic chemotherapy use has declined in recent years, EOL novel (immunotherapy and targeted therapy) use has increased. The association between use of novel therapies at EOL and health care utilization has not been widely studied.
Methods: We identified patients within SEER-Medicare who had part D coverage (excluding those with Medicare Advantage) age 66 years and older, and breast, colorectal, lung, prostate, bladder, cervical, kidney, liver, ovarian, pancreatic, melanoma, or uterine cancer. Patients were diagnosed between 2005 and 2019 and died between 2015 and 2020. We analyzed associations between EOL systemic anticancer therapy (SACT) use (overall and by subtype), and health care utilization in the last 30 days of life (emergency department [ED], hospitalization, intensive care unit [ICU], and inpatient death), and hospice with multivariable regression, controlling for sociodemographic and cancer covariates.
Results: Of 315,089 beneficiaries, 23,970 (7.6%) received SACT within 30 days of death. The breakdown by type was cytotoxic therapy 50.6%, immunotherapy 20.8%, targeted therapy 18%, and combination therapies 10.6%. After adjusting for covariates, any SACT use at EOL was associated with higher ED use (odds ratio [OR], 3.05 [95% CI, 2.95 to 3.15]), hospital admissions (OR, 2.64 [95% CI, 2.56 to 2.72]), ICU admission (OR, 1.78 [95% CI, 1.72 to 1.83]), hospital death (OR, 2.02 [95% CI, 1.96 to 2.08]), and lower hospice use (OR, 0.51 [95% CI, 0.50 to 0.53]) compared with no SACT. All subtypes of SACT were individually associated with higher health care utilization and lower hospice use (P < .001).
Conclusion: All subtypes of SACT use were associated with markers of worse-quality EOL care. These data can inform decisions for current care guidelines and efforts to reduce overutilization.
Journal of Clinical Oncology , résumé, 2025