Guidelines from the American Society of Clinical Oncology strongly advise "against cancer-directed therapy… in patients with advanced solid tumors who are unlikely to benefit from them."
Despite evidence-based Choosing Wisely recommendations, cancer patients under the age of 65 continue to receive aggressive care in the last 30 days of life, according to analysis presented on Monday at the American Society of Clinical Oncology (ASCO) meeting in Chicago.
Aggressive end-of-life care includes "cancer-directed procedures and therapies; emergency room and ICU admissions and in-hospital deaths," according to researchers from the University of North Carolina at Chapel Hill.
The researchers looked at data from 2007 to 2014 and found no reduction in the use of aggressive end of life care after ASCO issued the guidelines in 2012. They also saw an increase in end of life care for lung, pancreatic, and prostate cancer patients after 2012.
The ASCO guidelines strongly advise "against cancer-directed therapy (treatments that slow, stop or eliminate cancer) in patients with advanced solid tumors who are unlikely to benefit from them," according to a statement released with the study.
The researchers analyzed claims data for 29,000 patients enrolled in either Blue Cross and Blue Shield, or both, in 14 states.
The data covered the years 2007 to 2014 for those diagnosed with metastatic lung, colon, breast, pancreatic, and prostate cancers.
They found that 71% to 76% received aggressive care within the last 30 days of life. Between 30% and 35% died in the hospital. The rate of hospitalization during the study ranged from 61% for lung cancer and 65% for colon cancer.
The authors concluded: "There is substantial overuse of aggressive end-of-life care among younger patients with incurable cancers. Aggressive care did not decrease following the 2012 ASCO Choosing Wisely recommendations."
They noted, however, that the study is limited because the exact cause of death could not be determined.
Researchers did not review medical records, so they could not determine the medical reasons for aggressive care.