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Gregory J. Riely, MD, PhD
Gregory J. Riely, MD, PhD
Posted: Friday, August 30, 2024
Login S. George, PhD, of Rutgers University, New Brunswick, New Jersey, and colleagues aimed to evaluate the differences in systemic therapy prescriptions provided by oncologists for patients with cancer, more than 60% with lung cancer, during their last 30 days of life. Published in the journal Cancer, the results of this study suggest that further evaluations of cross-oncologist variability in end-of-life prescribing are warranted, since there is substantial variation in prescription behavior despite current guidelines and quality-of-life improvement initiatives proposing a reduction in these therapies during this time.
“We found oncologists to have varying propensities for providing end-of-life systemic therapies, with adjusted treatment rates ranging from 45% to 17% for those at the 95th and 5th percentile, respectively,” concluded the investigators. “Initiatives aimed at improving end-of-life cancer care must identify and address the factors driving some oncologists to have much higher propensities to continue treatments closer to death.”
The study authors identified 17,609 patients who died of cancer from 2012 to 2017—10,991 of whom died of lung cancer—as well as their treating oncologists (n = 960) and corresponding practice (n = 388) using Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Oncologists were categorized according to their percentile rank, represented as the bottom 25th (low), middle 50th (average), and top 25th (high) levels of end-of-life-prescribing behavior.
The median patient age at death was 74 years; most patients died with lung cancer (62.4%), followed by colorectal (17.2%), breast (12.9%), and prostate (7.5%) cancers. The multilevel model concluded that patients with breast cancer had higher odds of undergoing treatment than those with lung cancer (P < .001), and patients with colorectal and prostate cancers had similar odds to those with lung cancer. Overall, an individual treated by an oncologist in the high-prescribing percentile was over fourfold more likely than one treated by an oncologist in the low percentile to receive end-of-life cancer therapy.
Disclosure: The study authors reported no conflicts of interest.
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