Prevalence of Aggressive Cancer Care at End of Life Remains Unchanged

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The increase in integrated palliative care does not appear to have altered ACCEoL.
The increase in integrated palliative care does not appear to have altered ACCEoL.

Trends of aggressiveness of cancer care near the end of life (ACCEoL) have remained unchanged in adult patients despite increasing resources for integrated palliative care, according to results from a cohort study presented at the European Society of Medical Oncology (ESMO) 2017 Congress.

The purpose of this study was to evaluate the recent time trends and frequency of ACCEoL of adult patients with varying cancer types.

Study authors analyzed data from the Hospital Morbidity Database (HMD), and noted characteristics such as primary cancer site and presence of metastatic disease. The primary outcome was a composite ACCEoL indicator that compiled the presence of 1 to 14 individual indicators in the last 30 days of life or the use of chemotherapy, immunotherapy, or biological agents in the last 14 days of life.

A total of 92,155 patients were included in this study. The median age at baseline was 73 years, 62% of patients were male, and 53% of patients had metastatic disease. Study authors calculated the prevalence of individual and composite indicators and examined time trends in metastatic disease and main primary cancers. Any change greater than 5% was considered clinically meaningful.

The primary outcome stayed consistent over time, and despite statistically significant changes in some individual indicators, none of the changes were considered clinically meaningful.

Results show that the rate of ACCEoL was 71.1%, with 69.9% in patients with metastases compared to 72.6% in others (P <.001). The prevalence of ACCEoL also varied by type of primary cancer, with 62.7% in breast to 79.3% in hematologic cancers (P <.001).

The most common individual indicators of ACCEoL application were more than 14 days in hospital (42.7%; 42.3% in metastatic) and surgery (27.8%; 26.4% in metastatic). The least frequent individual indicators were permanent tracheostomy (0.1%) and percutaneous gastrostomy (0.3%).

The authors note that “The reduced ACCEoL in patients who died with slow progressive cancers (eg, breast) suggests that better knowledge of disease trajectories can contribute towards reducing ACCEoL.”

Reference

1. Martins Branco D, Lopes S, Canario R, et al. Prevalence and recent time trend in aggressiveness of cancer near the end of life: an expanded assessment in a cohort study. Oral presentation at: ESMO 2017 Congress; September 8-12, 2017; Madrid, Spain. Abstract 1387PD.

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