Patterns of anti-cancer therapy use in the last 14 days of life in a community cancer institute.

Abstract

66 Background: Studies have shown that aggressive cancer care at end of life is associated with decreased quality of life, decreased median survival, and increased cost of care. This study describes the patients most likely to receive aggressive anti-cancer therapy at the end of life in a community cancer institute. Methods: We performed a retrospective review of 213 patients who received anti-cancer therapy in our institution and died between July 2016-April 2017. Data collected included primary malignancy, death date, date of last anti-cancer treatment, hospice enrollment, healthcare utilization, Oncology Care Model (OCM) enrollment, and clinical assessments at last office visit prior to a treatment decision before death. Data were analyzed using univariate logistic regression to determine feature importance. Results: Of the 201 patients who died of cancer, 36 (17%) received anti-cancer therapy within the last 14 days of life. Several factors were significantly positively correlated with receiving anti-cancer therapy at end of life, including enrollment in OCM (p < 0.001), frequency of hospital utilization (p < 0.001), death in hospital (p<0.001), referral to hospice (p<0.001), and hematologic malignancy (p = 0.014). Conclusions: In our community cancer institute, enrollment in OCM, frequency of hospitalizations, death in a hospital, referral to hospice, and hematologic malignancy diagnosis were predictive of receiving aggressive anticancer therapy at the end of life, suggesting that these factors should have greater importance in our clinic. Taken as a whole, these data will help inform clinicians and patients in choices regarding care near the end of life.