Although supportive care has been recognized as an important element of end-of-life care, its use for patients with cancer aged 65 years or younger has not been previously described. A study examined the impact of ASCO’s 2012 Choosing Wisely campaign that promotes reducing the overuse of aggressive end-of-life care and opting for increased supportive care services, such as hospice, home health nursing, and palliative care consultations. The researchers presented the study at the ASCO Annual Meeting. 

The researchers used claims data from the HealthCore Integrated Research database that includes more than 60 million individuals enrolled in Blue Cross and/or Blue Shield licensed plans across 14 states. Patient information (N = 28,731) was included in the study from those who were aged 65 years or younger, had died between 2007 and 2014, and had been diagnosed for metastatic lung, colorectal, breast, pancreatic, or prostate cancers.

The researchers found that 39%–42% of patients received supportive care services in the 90 days prior to death, including 15%–19% who were enrolled in hospice (see Table for a breakdown of care). 

After the initiation of Choosing Wisely in 2012, supportive care services increased for those with lung (increased by 4%), colorectal (2%), breast (2%), and prostate (22%) cancers but decreased for those with pancreatic cancer (5%). 

The data also showed that 53%–55% of patients were prescribed medications for pain, anxiety, nausea, anorexia, depression, or delirium. 

The researchers concluded, “Use of supportive care services for younger patients at the end of life increased modestly for several common cancers after the 2012 ASCO Choosing Wisely recommendations. However, there remains substantial underuse of hospice, home health nursing, and palliative care consultation among these patients.”

Table. Supportive Care Used Within the Last 90 Days of Life
  Lung Cancer 
(n= 12,764)		 Colorectal Cancer
(n= 5,207)		 Breast Cancer
(n= 5,855)		 Pancreatic Cancer
(n= 3,397)		 Prostate Cancer
(n= 1,508)
Overall
supportive care		 39% 40% 39% 42%  40%
Hospice 16% 17% 15% 19%  17% 
Home health
nursing		 12% 12% 12% 11%  12% 
Palliative care 
consultation		 20% 19% 20%  21%  20%