While few patients receive radiation for cancer treatment in the last 30 days of life, almost 1 in 5 patients who do spend more than 10 of those days in treatment and more than half spend more than 5 days, according to a study published in the Journal of Clinical Oncology.1 The investigators used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked databases to analyze claims data for 202,299 patients dying as a result of lung, breast, prostate, colorectal, and pancreas cancers over a 5-year period.
“These cancers were chosen because they accounted for the top five most common causes of cancer deaths and comprised almost 60% of cancer deaths in 2010,” the researchers explained.
Among the 15,287 patients (7.6%) who received radiation therapy in the last month of life, 2,721 (17.8%) received more than 10 days of treatment and 53.7% received more than 5 days of treatment. Nonclinical factors associated with a greater probability of receiving radiotherapy for more than 10 days in the last 30 days of life included non-Hispanic white race, no hospice care, and treatment in a “freestanding” (vs hospital-associated) facility, the researchers reported.
“We found a decreasing use of radiotherapy in the last 30 days of life from 2000 to 2007, which corresponded to an increasing trend in hospice enrollment,” the authors noted. Other factors associated with significantly greater likelihood of receiving radiation therapy included lung cancer as the cause of death, younger age, male sex, being married, and living in an urban area.
Cost of Care
“We found that the costs of care for patients who received radiotherapy at the end of life were higher than for those patients who did not,” the investigators stated. “Any debate about the costs of radiotherapy at the end of life must include acknowledgment of the palliative benefits to patients, such as decreased pain or improved neurologic functioning potentially offered through a course of conventional short-course radiotherapy. Also, increased costs could be due to complications of cancer that resulted in hospitalizations and need for radiotherapy, rather than radiotherapy itself.”
The authors acknowledged that it is possible that the low percentage of patients who received radiotherapy in the last 30 days of life could reflect “underuse of this modality in end-stage cancer care. However, dosing regimens that require dying patients to spend a significant proportion of their final days visiting a radiation therapy suite likely counters the overall aim of palliative care.” ■
1. Guadagnolo BA, et al: J Clin Oncol. November 12, 2012 (early release online).