Researchers: Pesach Shvartzman¹, Natan Kahan², Dan Waitman²

Background: Cultural and emotional factors are associated with decisions concerning administration of cancer chemotherapy in patients who are unlikely to benefit from treatment.

Objectives: To calculate the rate of treatment with antineoplastic drugs during the last year of life among patients that died of cancer, and to compare health resource utilization patterns amongst these patients with those that were not treated with chemotherapy at end of life.

Method: Cross-sectional study of members of Leumit Health Services (LHS) that died with cancer between 2009 and 2013. Data captured from LHS databases included: target drugs prescribed, diagnoses, resource utilization, and demographic data. Patients were stratified by time elapsed between last chemotherapy treatment and date of death: 0-14, 15-30, 31-90, 91-180 and >180 days. Rates were calculated for each sub-stratum and resource utilization patterns were compared between groups.

Findings: The study included 4,667 patients, 10.5% of whom received chemotherapy 0-14 days prior to death. Administration of palliative care was lowest amongst patients who did not receive chemotherapy at all prior to death (12.3%) and highest amongst patients receiving chemotherapy 91-180 days prior to death (28.1%: P<0.0001).

Conclusions: The probability of administering palliative care at end of life is inversely associated with the probability of administering antineoplastic chemotherapy.

Recommendations: Efforts should be made to increase awareness amongst patients, oncologists and other relevant stakeholders regarding the availability and benefits of palliative care for terminal cancer patients. The prevalence of aggressive treatment observed during the last weeks of life indicates that palliative care may often be a superior treatment strategy to expensive yet futile drug regimens.

Research end date: 12/2016