Systemic Therapy in Cancer Patients Increases in Use and Cost During the Final Year of Life

Study finds need for improved understanding of the association between rising systemic therapy use and the uptake of palliative care.

A recent study concluded that systemic therapy is increasing both in utilization and cost, as a better understanding on patient quality of life during their final days needs to be achieved.

In order to understand the patterns, researchers looked to describe trends in systemic therapy use and cost — hormonal therapy, targeted drugs, and immunotherapy.

Researchers used data from the BC Cancer Registry between January 1, 2002, and December 31, 2007, of patients who died of malignant neoplasms. The study cohort was limited to patients diagnosed less than 5 years, but more than 3 months before death, and who were at least 19-years-old at the time of diagnosis.

The data was then linked to pharmacy dispensing records from the province’s Systemic Therapy Program to obtain prescription dates, drug names, and costs.

Any dispensing record for a systemic therapy drug was used as an indicator variable, while the total cost for systemic therapy was calculated from the dispensed drug’s ingredient costs during the last 12-4 months of life and the last 3 months of life.

During the study, a multivariable logistic regression was used to analyze changes in systemic therapy use over time. Changes in mean costs for systemic therapy users were analyzed using generalized liner models with a log-link function and gamma distribution, with both adjusted for age, sex, and survival.

A subgroup analyses was conducted for patients with primary colorectal, prostate, lung, or breast cancer.

The results of the study showed that there were significantly more patients who received systemic therapy in the last 12-4 months of life (41.4%; 95% ci: 40.8% to 42.0%) than in the last 3 months of life (30.6%; 95% ci: 30.0% to 31.2%; p < 0.0001). No significant changes in use were found in the last 3 months of life.

Both periods saw an increase in cost over time by 48% (95% ci: 36% to 63%) and by 33% (95% ci: 19% to 49%), respectively.

The trends varied amongst the different cancer sites, but patients with lung and colorectal cancer saw the greatest increases.

Colorectal cancer patients had costs that more than doubled from $5895 (95% ci: $5027 to $6810; p = 0.009) to $12,618 (95% ci: $11,083 to $14,244), while no change was seen for breast cancer patients (P=0.74).

For lung cancer patients in the last 3 months of life, the mean cost of systemic therapy increased from $829 (95% ci: $673 to $995) in 2002 (p < 0.001) to $2262 (95% ci: $1951 to $2602) in 2007.

Little change was seen during that period for breast, colorectal, or prostate cancer, or for the full cohort.

An increase in use and cost for cancer patients taking systemic therapy in the last year of life was noted during the study, but more work is needed to determine the extent of which the increase is appropriate or not, and whether the rising expenditure gives value to patients and health care systems.

Although early palliative care can be delivered concurrently with anticancer therapy and also help maintain quality of life for patients, a better understanding of the association between increased systemic therapy use and the uptake of palliative care is needed to understand the impact it has on patient care and quality of life as they near death.