Oncologist Variability in End-of-Life Cancer Treatment: A New Study Reveals Key Insights
A new study by George et al. (2024), published in Cancer, sheds light on the significant variability among oncologists in prescribing systemic cancer therapies to patients during their last 30 days of life. While clinical guidelines advocate for reducing aggressive treatments at the end of life to prioritize patient comfort, oncologists differ greatly in their prescribing patterns. This research explores the extent of this variation and its potential implications.
Key Findings
1. Substantial Variation Among Oncologists
The study analyzed data from 17,609 patients who died of cancer between 2012 and 2017.
Some oncologists (5th percentile) treated only 17% of their terminal patients with systemic therapy, while others (95th percentile) prescribed such treatments for 45% of their patients.
Patients treated by oncologists in the highest prescribing quartile were four times more likely to receive end-of-life cancer therapy than those treated by oncologists in the lowest quartile.
2. Demographic Trends in Treatment
Older patients and those with late-stage cancers were less likely to receive systemic therapy.
Black patients had lower odds of receiving treatment than White patients.
Breast cancer patients were more likely to receive systemic therapy than lung, colorectal, or prostate cancer patients.
3. Impact on Patient Outcomes
Patients treated by oncologists with high prescribing rates were more likely to be hospitalized and less likely to receive hospice care compared to those treated by oncologists with lower prescribing tendencies.
This suggests that aggressive end-of-life treatment might not align with palliative care goals.
Why Does This Variation Exist?
The study suggests multiple factors influencing oncologist behavior:
Clinical Uncertainty: Oncologists may struggle to determine when to stop treatment.
Patient and Family Expectations: The emotional difficulty of discontinuing treatment can lead to prolonged therapy.
Physician Training and Preferences: Some oncologists may prioritize aggressive treatment over palliative care.
Institutional and Regional Norms: Differences in practice settings and medical culture can shape decision-making.
What Can Be Done?
To reduce unnecessary end-of-life treatments, the study recommends:
Improved Guidelines & Decision Tools: Providing clear protocols for discontinuing treatment.
Oncologist Training: Enhancing communication skills for discussing prognosis and palliative options.
Audit & Feedback Mechanisms: Helping oncologists reflect on their prescribing patterns.
Conclusion
The study highlights the need for a more standardized approach to end-of-life cancer care. By addressing oncologist-related variations, healthcare systems can better align treatment with patient-centered goals, ensuring quality end-of-life care.
Reference
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This blog was reviewed by Dr. Sourabh Kharait.
This blog is for educational purposes only and is not intended as medical advice. Always consult with your healthcare provider before making any changes to your treatment plan, hydration strategies, or diet. The information provided here is based on general insights and may not apply to individual circumstances.
