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Aggressiveness of Cancer Care Near the End of Life: Is It a Quality-of-Care Issue?

Craig C. Earle, Mary Beth Landrum, Jeffrey M. Souza, Bridget A. Neville, Jane C. Weeks, John Z. Ayanian

From the Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute; Department of Health Care Policy, Harvard Medical School; and the Division of General Medicine, Brigham and Women's Hospital, Boston, MA

Corresponding author: Craig C. Earle, MD, MSc, Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room G-106, Toronto, Ontario, M4N 3M5 Canada; e-mail: craig.earle{at}ices.on.ca

The purpose of this article is to review the literature and update analyses pertaining to the aggressiveness of cancer care near the end of life. Specifically, we will discuss trends and factors responsible for chemotherapy overuse very near death and underutilization of hospice services. Whether the concept of overly aggressive treatment represents a quality-of-care issue that is acceptable to all involved stakeholders is an open question.

Supported by Grant No. CA 91753-02 from the National Cancer Institute.

Presented in part at 42nd Annual Meeting of the American Society of Clinical Oncology, June 2-6, 2006, Atlanta, GA.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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