National guidelines suggest that the use of chemotherapy near end of life (EOL) is aggressive and is associated with poorer patient quality of life. In addition, Medicare payments for outpatient chemotherapy have decreased since around 2005–2006. In a recent study presented at the 2017 ASCO Annual Meeting, researchers evaluated the impact of U.S. payment reform and guidelines on chemotherapy use at EOL, comparing chemotherapy use at EOL in the United States and other countries.

The researchers systematically assessed six databases through January 2017 for population-based studies of chemotherapy use at EOL for patients with different types of cancer.

The researchers identified nine U.S. articles and seven non-U.S. articles. Chemotherapy was provided to 28.9% of patients (95% confidence interval [CI] = 26.2–31.8) in the last six months of life, to 23.2% of patients (95% CI = 21.7–24.8) in the last three months of life, to 10.0% of patients (95% CI = 8.5–11.8) in the last month of life, and to 4.5% of patients (95% CI = 3.9–5.2) in the last 14 days of life.

Chemotherapy use in the last six months of life was more common in the United States (32.4%) compared to other countries (26.2%; p = 0.015). However, chemotherapy use in the last month of life was similar between the United States (4.6%) and other countries (5.6%; p = 0.683).

Chemotherapy use during the last 14 days of life in the United States did not significantly differ before and after 2007 (5.1% versus 5.2%; p = 0.967).

“The prevalence of chemotherapy use in U.S. patients’ last 14 days of life was virtually unchanged over time,” the authors concluded. “Effective interventions should be developed and provided to offset the trend of continuing chemotherapy use at EOL.”

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