Chemotherapy Use in the Last 6 Months of Life among Medicare Patients with Cancer

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The summary below is from the full report titled "Chemotherapy Use among Medicare Beneficiaries at the End of Life." It is in the 15 April 2003 issue of Annals of Internal Medicine (volume 138, pages 639-643). The authors are E.J. Emanuel, Y. Young-Xu, N.G. Levinsky, G. Gazelle, O. Saynina, and A.S. Ash.

What is the problem and what is known about it so far?

The use of drugs to treat cancer is called chemotherapy. Some people worry that doctors prescribe chemotherapy for patients with cancer even when treatment is not likely to help the patient live longer. No studies show how frequently patients with cancer receive chemotherapy in the months before death.

Why did the researchers do this particular study?

To see how often patients with cancer received chemotherapy in the months before they die.

Who was studied?

The researchers studied all Medicare patients with cancer in Massachusetts and a sample of Medicare patients with cancer in California who died in 1996. Medicare is the health insurance program for Americans over 65 years of age.

How was the study done?

Using Medicare databases, the researchers determined whether patients received chemotherapy in each of the 6 months before death. They compared the frequency of chemotherapy use in patients with types of cancer that usually respond to chemotherapy and in patients with types of cancer that do not usually respond to chemotherapy.

What did the researchers find?

In Massachusetts, 33% of the patients received chemotherapy in the last 6 months of life, 23% in the last 3 months of life, and 9% in the last month of life. The numbers were similar in California. Chemotherapy use was less common as patients got older. Chemotherapy use in the last 6 months of life was similar for people with types of cancer that were responsive and nonresponsive to chemotherapy.

What were the limitations of the study?

This study examined only two states and only Medicare patients. The results might be different in other locations or in other types of patients. In addition, the study does not provide information about the reasons for chemotherapy use.

What are the implications of the study?

During the last 6 months of life, many Medicare beneficiaries with cancer receive chemotherapy, regardless of the type of cancer they have. About one quarter of patients with cancer older than 65 years of age receive chemotherapy in the last 3 months of life. Unfortunately, this study does not tell us why.