Oncologists Play a Crucial Role in Cancer Patients' End-of-Life Decisions

For patients facing terminal cancer, the decision-making process in the final days of life is deeply personal. They often grapple with the choice of continuing aggressive treatments or opting for a more comfortable end-of-life experience. However, a recent study from Rutgers University reveals that the preferences of patients may not always align with the treatments they receive, highlighting the influential role oncologists play in these critical decisions.

The study, published in the journal Cancer, emphasizes that the end-of-life experience for cancer patients frequently reflects the practices and habits of their oncologists rather than the patients' own desires. Researchers discovered that oncologists' treatment patterns significantly impact whether patients receive chemotherapy in their final days, raising concerns about the alignment of care with patient-centered preferences.

According to the findings, clinical guidelines recommend discontinuing chemotherapy in the last days of life as it may often do more harm than good. Despite this guidance, the study indicates that oncologists might rely on habitual treatment approaches instead of tailoring decisions based on individual patient circumstances and preferences.

To better understand the dynamics at play, the research team analyzed national data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program. They examined billing records for Medicare hospital outpatient and carrier claims, focusing on 17,609 patients who died from breast, lung, colorectal, or prostate cancer between 2012 and 2017. The analysis included 960 oncologists across 388 practices and clinics.

Using advanced statistical models, the researchers assessed the rates at which oncologists prescribed chemotherapy and other systemic therapies to their patients during the last two weeks of life. Oncologists were categorized based on their prescribing behavior--those who prescribed at higher rates compared to their peers were labeled as having 'high' prescribing behavior, while those who prescribed less were deemed to have 'low' prescribing behavior.

The results were striking: patients treated by oncologists with high prescribing habits had a 4.5 times greater likelihood of receiving cancer treatment in their final days compared to those under oncologists with low prescribing tendencies. Notably, the study found that breast cancer patients were more likely to receive late-stage treatment than those with lung cancer. Additionally, disparities emerged in treatment patterns based on patient demographics--Black patients had lower odds of receiving treatment in their last month compared to their white counterparts, and unmarried patients were also less likely to receive treatment than those who were married.

While the data was anonymized, preventing identification of specific oncologists or practices, the findings underscore a concerning variability in end-of-life care for terminally ill cancer patients. The researchers advocate for greater transparency in treatment patterns, suggesting that making such information publicly accessible could help align patients' wishes with the care they receive.

The lead researcher expressed that just as consumers evaluate restaurants and products based on reviews, cancer patients should have the same opportunity to assess their healthcare providers. This transparency could empower patients to make informed decisions regarding their care.

Future research will delve into the factors influencing decisions between pursuing aggressive cancer treatments versus opting for hospice care, as understanding these dynamics is crucial for improving patient-centered care.