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Review
. 2008 Aug 10;26(23):3860-6.
doi: 10.1200/JCO.2007.15.8253.

Aggressiveness of cancer care near the end of life: is it a quality-of-care issue?

Craig C Earle  1 , Mary Beth Landrum, Jeffrey M Souza, Bridget A Neville, Jane C Weeks, John Z Ayanian
Affiliations
Review

Aggressiveness of cancer care near the end of life: is it a quality-of-care issue?

Craig C Earle et al. J Clin Oncol. .

Erratum in

  • J Clin Oncol. 2010 Jul 1;28(19):3205
  • J Clin Oncol. 2011 Nov 20;29(33):4472

Abstract

The purpose of this article is to review the literature and update analyses pertaining to the aggressiveness of cancer care near the end of life. Specifically, we will discuss trends and factors responsible for chemotherapy overuse very near death and underutilization of hospice services. Whether the concept of overly aggressive treatment represents a quality-of-care issue that is acceptable to all involved stakeholders is an open question.

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Figures

Fig 1.
Fig 1.
Updated trends in the aggressiveness of cancer care near the end of life, all cancer types, all durations of disease among 215,484 Medicare enrollees in Surveillance, Epidemiology, and End Results (SEER) areas who died as a result of cancer. (*) Among patients admitted to hospice. (†) Among patients who received chemotherapy. ER, emergency room; ICU, intensive care unit.
Fig 2.
Fig 2.
Maps showing distribution of aggressive chemotherapy use and hospice underutilization among 215,484 Medicare enrollees in Surveillance, Epidemiology, and End Results (SEER) Health Care Service Areas (HSCAs) who died as a result of cancer between 1991 and 2000. Gray HCSAs were ranked in the top 25 of 77 HCSAs monitored by SEER every year for 10 years, blue HCSAs were ranked in the bottom 25, and the rest are indicated by yellow. White HCSAs are those not monitored by the SEER program.
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References

    1. Rowland J, Mariotto A, Aziz N, et al: Cancer survivorship: United States, 1971-2001. MMWR 53:526-529, 2004 - PubMed
    1. National Cancer Policy Board: Ensuring Quality Cancer Care. Washington, DC, National Academy Press, 1999
    1. Earle CC, Park ER, Lai B, et al: Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol 21:1133-1138, 2003 - PubMed
    1. Earle CC, Neville BA, Landrum MB, et al: Evaluating claims-based indicators of the intensity of end-of-life cancer care. Int J Qual Health Care 17:505-509, 2005 - PubMed
    1. Earle CC, Neville BA, Landrum ME, et al: Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol 22:315-321, 2004 - PubMed

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