Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec 1;8(12):1847-1849.
doi: 10.1001/jamaoncol.2022.4666.

Systemic Anticancer Therapy at the End of Life-Changes in Usage Pattern in the Immunotherapy Era

Maureen E Canavan  1 , Xiaoliang Wang  2 , Mustafa S Ascha  2 , Rebecca A Miksad  2   3 , Gregory S Calip  2   4 , Cary P Gross  1 , Kerin B Adelson  1
Affiliations

Systemic Anticancer Therapy at the End of Life-Changes in Usage Pattern in the Immunotherapy Era

Maureen E Canavan et al. JAMA Oncol. .
No abstract available

Plain language summary

This cohort study evaluates the rate of systemic anticancer therapy use among patients dying of cancer.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Wang reported being employed by Flatiron Health Inc and owning stock in the Roche Group during the conduct of the study. Dr Ascha reported being employed by Flatiron Health Inc during the conduct of the study and holding equity in the Roche Group outside the submitted work. Dr Miksad reported being employed by Flatiron Health Inc and holding equity the Roche Group during the conduct of the study. Dr Calip reported being employed by Flatiron Health Inc; holding stock in Roche Group during the conduct of the study; and receiving grants from Pfizer awarded to University of Illinois Chicago outside the submitted work. Dr Gross reported receiving grants from Johnson & Johnson, research funding from Genentech, and grants from AstraZeneca (administered by National Comprehensive Cancer Network) outside the submitted work. Dr Adelson reported holding stock options with Carrum Health, Lyra Health, and Brightline Health; receiving funding from Genentech; serving on advisory boards for AbbVie Oncology; and receiving personal fees from Projects in Knowledge for leading continuing medical education and research activity on shared decision-making in breast cancer. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Adjusted Mean Treatment Rates Across All Cancer Types by Treatment Type and Year
Patients were excluded if they had more than 90-day gap between index cancer diagnosis and first documented visit, more than 1 cancer diagnosis, or more than 6-month gap between last confirmed activity and date of death, or if they were treated at practices that were not in operation in 2015 or had less than 200 patient to physician ratios or fewer than 30 decedents. Multivariable models were adjusted for patient-level factors (age at diagnosis, sex, race and ethnicity, Eastern Cooperative Oncology Group performance status, insurance categories, primary cancer diagnosis, started second-line within 6 months of diagnosis, lines of therapy, and year of death) and practice-level factors (practice size, patients per physician ratio, practice type, region, proportion of Black patients, and proportion of patients with Medicaid). EOL indicates end of life.
Figure 2.
Figure 2.. Adjusted Practice-Level 30-Day End-of-Life Treatment Rates by Disease
The same exclusion criteria were applied to the disease-specific models as those in overall cancer models (Figure 1). NSCLC indicates non–small cell lung cancer.
See this image and copyright information in PMC

References

    1. McPherson JP, Patel SB, Igumnova E, et al. . Real-time assessment of resource utilization and subsequent cost analysis in cancer patients (pts) near the end of life (EOL). J Clin Oncol. 2018;36(30 suppl):303. doi:10.1200/JCO.2018.36.30_suppl.303 - DOI - PubMed
    1. Starr LT, Ulrich CM, Corey KL, Meghani SH. Associations among end-of-life discussions, health-care utilization, and costs in persons with advanced cancer: a systematic review. Am J Hosp Palliat Care. 2019;36(10):913-926. doi:10.1177/1049909119848148 - DOI - PMC - PubMed
    1. Temel JS, Greer JA, Muzikansky A, et al. . Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742. doi:10.1056/NEJMoa1000678 - DOI - PubMed
    1. Parikh RB, Galsky MD, Gyawali B, et al. . Trends in checkpoint inhibitor therapy for advanced urothelial cell carcinoma at the end of life: insights from real-world practice. Oncologist. 2019;24(6):e397-e399. doi:10.1634/theoncologist.2019-0039 - DOI - PMC - PubMed
    1. Riaz F, Gan G, Li F, et al. . Adoption of immune checkpoint inhibitors and patterns of care at the end of life. JCO Oncol Pract. 2020;16(11):e1355-e1370. doi:10.1200/OP.20.00010 - DOI - PMC - PubMed