The study addresses growing concerns regarding aggressive cancer treatment at the end of life. The extent of anticancer treatment at the end of life of breast, prostate, and colorectal cancer patients aged 60 years and older as well as its development in recent years is investigated.
Routine data of the statutory health insurance company AOK Hessen in Germany (approx. 1.4 million assured persons in 2014) for 2008-2013 are analyzed. Cancer patients are identified using ICD-10 codes: breast (C50), prostate (C61), and colorectal cancer (C18-21), and validated using inpatient and outpatient diagnoses. The last year before death is examined in 90-days periods and, in addition, the last 90 days in 30-days periods.
Key results are that cancer patients aged 80 years and older less often receive anticancer therapy at the end of life (e.g. women with breast cancer in 2013: 20% in the last 90 days, 6% in the last 30 days before death) than patients aged 60-69 (56% and 29%) or 70-79 (46% and 18%). There is no clear development toward a reduction in anticancer treatment in women with breast cancer at the end of life between 2008 and 2013. The number of anticancer therapies at the end of life in men with prostate cancer aged 60-69 years reduced between 2008 and 2013, especially in the second (2008: 56%, 2013: 49%) and third 90-days period from last (2008: 57%, 2013: 45%) and reached the same level as patients aged 70-79. There are differences in the number of anticancer therapies between men and women with colorectal cancer at the end of life. Especially, women aged 80 and older with colorectal cancer rarely receive anticancer therapy in the year before death (in 2013: 5% in the last 90 days, 1% in the last 30 days before death) compared to men (12% and 5%).
These results support increased sensitivity regarding anticancer treatment at the end of life. To further investigate these results, studies should include cancer staging, general health status, and patient reported outcomes such as quality of life.
Clinical trial identification
Legal entity responsible for the study
WINHO GmbH & Universität Köln / PMV Forschungsgruppe.
Zentralinstitut für die kassenärztliche Versorgung.
All authors have declared no conflicts of interest.