Ezekiel J. Emanuel, MD, PhD; Yinong Young-Xu, MA; Norman G. Levinsky, MD; Gail Gazelle, MD; Olga Saynina, MA; Arlene S. Ash, PhD
Although many observers believe that cancer chemotherapy is overused at the end of life, there are no published data on this.
To determine the frequency and duration of chemotherapy use in the last 6 months of life stratified by type of cancer, age, and sex.
Retrospective cohort analysis.
Administrative databases from Massachusetts and California.
All Medicare patients who died of cancer in Massachusetts and 5% of Medicare cancer decedents in California in 1996.
Use of intravenous chemotherapy agents, chemotherapy administration, or medical evaluation for chemotherapy from Medicare billing data for each patient in 30-day periods from the date of death backward.
In Massachusetts, 33% of cancer decedents older than 65 years of age received chemotherapy in the last 6 months of life, 23% in the last 3 months, and 9% in the last month. In California, the percentages were 26%, 20%, and 9%, respectively. Chemotherapy use greatly declined with age. Chemotherapy use was similar for patients with breast, colon, and ovarian cancer and those with cancer generally considered unresponsive to chemotherapy, such as pancreatic, hepatocellular, or renal-cell cancer or melanoma. Patients with types of cancer that are unresponsive to chemotherapy had shorter duration of chemotherapy use.
Among patients who died of cancer, chemotherapy was used frequently in the last 3 months of life. The cancer's responsiveness to chemotherapy does not seem to influence whether dying patients receive chemotherapy at the end of life.
Some worry that physicians prescribe chemotherapy for patients with cancer at the end of life even when treatment is unlikely to prolong life or palliate symptoms.
Among the study sample of Medicare beneficiaries who died of cancer in 1996, the proportions that received chemotherapy were about 30%, 20%, and 10% in the last 6, 3, and 1 months of life. Chemotherapy use was similar for types of cancer that usually respond to chemotherapy and those that do not.
During the last 6 months of life, many Medicare beneficiaries with cancer receive chemotherapy, regardless of the type of cancer they have. Unfortunately, this study does not tell us why.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Emanuel EJ, Young-Xu Y, Levinsky NG, Gazelle G, Saynina O, Ash AS. Chemotherapy Use among Medicare Beneficiaries at the End of Life. Ann Intern Med. 2003;138:639-643. doi: 10.7326/0003-4819-138-8-200304150-00011
Download citation file:
Published: Ann Intern Med. 2003;138(8):639-643.
End-of-Life Care, Healthcare Delivery and Policy, Hematology/Oncology.
Results provided by:
Copyright © 2017 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only