Retrospective Study: Palliative Care Remains Underused

A retrospective study published in the Journal of the American Medical Association (JAMA) Health Forum and led by American Cancer Society (ACS) researchers found that close to half of patients with advanced cancer received potentially aggressive care at the end-of-life at the expense of supportive care, despite considerable efforts to improve the quality of end-of-life care in the United States.

“Even though clinicians and professional healthcare organizations have recommended early integration of supportive and palliative care for all patients with advanced cancers, it remains underused,” said Robin Yabross, Ph.D., M.B.A., scientific vice president of health services research at the American Cancer Society and senior author of the study, in a statement. “High-quality patient-centered end-of-life care is especially important for maximizing remaining quality of life for this population, yet uptake of advanced care planning and palliative care was low and late hospice enrollment was common.”

Researchers analyzed information from the Surveillance, Epidemiology, and End Results (SEER) program linked with Medicare data to characterize patterns of end-of-life care. The study included 33,744 patients aged 66 or older with fee-for-service Medicare health insurance coverage who were initially diagnosed with distant-stage breast, prostate, pancreatic, or lung cancers and died between 2014 and 2019. 

Monthly utilization of acute care, systemic therapy, and supportive care (i.e., palliative and hospice care and advanced care planning) were examined in the last six months of life. Additionally, a claims-based indicator was used to examine potentially aggressive care in the last 30 days of life, defined as experiencing more than one acute care visit, in-hospital mortality, late receipt of systemic therapy, or hospice entry.

Study results showed only one-quarter of patients diagnosed with advanced cancer received any palliative care in the last six months of life, and those who received it did so mainly in the month of death. Overall, 45% of decedents experienced any indicator of potentially aggressive care. There was an increase in the mean number of acute care visits (from 14.0 to 46.2 per 100 person-months), hospice use (from 6.6 to 73.9 per 100 person-months), palliative care (from 2.6 to 26.1 per 100 person-months), and advanced care planning (from 1.7 to 12.8 per 100 person-months) over the last 6 months of life.

“This research highlights the need for interventions to improve quality of care for patients with advanced cancers, especially those helping to remove barriers to better access palliative care,” Yabroff added. “It also suggests the importance of clear, proactive communication between providers and patients and their families regarding advanced care planning to better guide end-of-life care efforts.”