Understanding oral chemotherapy use at the end of life: Analysis of a Massachusetts claims database.

Abstract

8 Background: Receipt of chemotherapy in the last 14 days of life is a measure of potential overuse of care. But the appropriateness of oral chemotherapy specifically is not yet described, and there are little available data on utilization of oral chemotherapy at the end of life. Methods: We analyzed results from 200 patients of Dana-Farber Cancer Institute, covered by the Blue Cross/Blue Shield of Massachusetts (BCBSMA) pharmacy benefit, and who died in 2012. We collected data on chemotherapy use in the last 6 months of life. We analyzed oral chemotherapy use in the categories of any oral prescription and timing of first oral prescription. We compared results to intravenous (IV) and any other administration route. Results: Most of our target population had gastrointestinal, thoracic, or breast malignancies. In the last 6 months of life, 75% received some form of chemotherapy, including 23.5% who were prescribed an oral agent. 11 patients were prescribed oral chemotherapy in the last 30 days of life. For 45% (n=5) this was the first oral prescription. In the last 14 days of life, only 5.5% of patients received any chemotherapy, including one patient prescribed an oral agent. Conclusions: The collection of oral chemotherapy utilization data through insurance claims was feasible. Use of any chemotherapy, including oral, sharply declined during the last 30 and 14 days of life, consistent with a shift to palliative end-of-life management. This analysis highlights the need for a more comprehensive understanding of oral chemotherapy use at the end of life. Furthermore, with the growing use of oral chemotherapy, the development of measures to define quality of end-of-life care with these agents is warranted. [Table: see text]