John Z. Ayanian is site principal investigator on this project. Debby Collins is the project contact: 617-432-3467.

Concern has been raised about the lack of data on the quality of cancer care near the end of life. In previous research, this study team identified overuse of chemotherapy, underuse of hospice services, and frequent emergency room visits, hospitalizations, and intensive care unit (ICU) admissions near the end of life as potential quality indicators meriting further evaluation. Implementation in Medicare claims for older patients with terminal lung, breast, colorectal, and other gastrointestinal cancers found steadily increasing use of chemotherapy very near death over a four-year span in the mid-1990s, a trend that was also associated with a rise in potentially negative outcomes such as increased ICU admissions and delayed hospice admission.

In this study, the researchers are further evaluating these quality-of-care indicators by assessing trends in end-of-life cancer care for patients with different types of cancer and those dying more recently, and they are evaluating the outcomes associated with aggressive care near death. In particular, they are analyzing the relation of aggressive care identified through Medicare claims with family members’ evaluations of the quality of cancer care in the last months of life.