Many Medicare patients with advanced cancer receive potentially aggressive treatment at the expense of supportive care, according to a study that analyzed Medicare records.
The , published in JAMA Health Forum, examined the quality of end-of-life care among 33,744 Medicare decedents. The study involved patients of diverse ethnic backgrounds age 66 or older who died from breast, prostate, pancreatic or lung cancers.
Overall, claims records showed that 45% of the patients experienced potentially aggressive care (such as multiple acute care visits within days of death), while there was a low receipt of supportive care, such as palliative, hospice and advanced care planning in the last six months of life. While hospice care spiked to more than 70% during the month that death occurred, over 16% of patients spent less than 3 days in hospices. Moreover, receipt of advanced care planning and palliative care remained below 25%.
“Care at end-of-life continues to favor over-treatment despite considerable efforts to raise awareness about the harms of aggressive treatment in the last decade,” said Youngmin Kwon, PhD, a research fellow with the Department of Health Policy at Vanderbilt University Medical Center.
Access to supportive care varied among demographic groups. Patients who were older, non-Hispanic white, had longer survival durations, or lived in rural areas, as well as areas with lower socioeconomic levels, were less likely to receive supportive care.
“For dying patients and their caregivers, hospice is often considered the gold standard of end-of-life that can holistically manage care needs,” the authors noted. “The fact that a considerable portion did not use hospice care at all or entered into hospice care within 3 days of death suggests the potential benefits of hospice care were not realized for many patients.”
The findings underscore the need for multi-faceted efforts to optimize the quality of end-of-life care for cancer patients.
“Having clear and honest communication between patients, their caregivers, and providers regarding disease prognosis and advanced planning is crucial,” said Kwon. “At the same time, policies to increase access to supportive care and ensure an adequate workforce of palliative care providers are necessary to address structural barriers to high-quality care.”
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