Many targeted agents that are administered orally are lower in toxicity than are intravenous chemotherapeutic agents, which make them an attractive alternative for end-of-life (EOL) treatment. Nonetheless, researchers have shown that near-death chemotherapy typically involves a continuation of aggressive care and late hospice referrals. The effects of continuing targeted therapy on the quality of EOL care is largely unknown, and researchers have yet to identify the factors that predispose patients to receive near-death targeted therapy.
Dr. Raymond N. Kuo is an assistant professor at the Institute of health policy and management in the National Taiwan University College of Public Health. He is the corresponding author of an article published in the March 2018 issue of the Journal of Pain and Symptom Management, titled, “Impact of Targeted Therapy on the Quality of End-of-Life Care for Patients With Non-Small-Cell Lung Cancer: A Population-Based Study in Taiwan.” This study investigated the determinants of receiving targeted therapy during the last month of life and how targeted therapies affect the quality of EOL care.
Using the cancer registry and National Health Insurance claims data pertaining to 42,678 Taiwanese non-small-cell lung cancer decedents for the period from 2005 to 2012, it was revealed that pulmonologists, oncologists, younger physicians, and physicians with a higher service volume were more likely to prescribe EOL targeted therapies. They also showed that patients who were prescribed targeted therapy near death were significantly more likely to undergo aggressive EOL care (odds ratio=2.35), including multiple emergency room visits, hospitalization exceeding 14 days, admission to intensive care units, use of intubation and mechanical ventilation, cardiopulmonary resuscitation, and late hospice referral.
“Our study shows that the benefits of these agents during the last 30 days of life is negligible, which means that prescribing them may be inappropriate,” says Dr. Kuo. “Many patients choose to undergo active treatment at EOL, despite the fact that they are unlikely to benefit from targeted therapy. We believe that is largely due to insufficient information concerning their prognosis and the risks of treatment.”
This study provides evidence that targeted therapy near death is associated with aggressive care and late hospice referrals. The decision-making process underlying the initiation and cessation of targeted therapy at EOL needs to be explored further.
Full report in Journal of Pain and Symptom Management.