Expensive and more aggressive treatments for cancer with “enormous personal and financial costs” are more common among nursing home residents compared to older adults who live in the community.
This is according to a study published in JAMA, which notes that the higher use of aggressive medical interventions for nursing home residents at end-of-life (EOL) should not be the treatment of choice over other more useful approaches such as early enrollment in palliative care.
“[D]espite the increased emphasis on reducing aggressive EOL care, such care remains highly prevalent among older persons with metastatic cancer and is more common among [nursing home] residents than their community-dwelling counterparts. Interventions to decrease aggressive EOL care should target the main factors associated with its prevalence, including hospital admissions in the last 6 months of life and in-hospital death,” the researchers wrote.
Aggressive care also increases the costs and burdens from disease given frequent use of emergency rooms, hospital stays, intensive care use and delay in accessing hospice programs, the researchers noted.
The benefits to such stringent means of cancer care, however, are little to none, they said. In recommending early enrollment in palliative care, researchers said that it was linked to improvements in quality of life, longer survival, and reduced costs in the last month of life, primarily through reduced hospitalizations.
Nearly 150,000 of the more than 1.5 million persons residing in nursing homes in the United States have received or will receive a diagnosis of cancer.
The study’s population included 146, 329 older adults with an average age of 78.8 years with active metastatic breast, colorectal, lung, pancreas, or prostate cancer. About 28.0% of the sample was made up of nursing home residents.
Researchers wrote that in the United States, nursing home stays at the end of life are common among older adults, with 43.5% of Medicare fee-for-service beneficiaries having stayed in a nursing home in the last 90 days of life, and 25% dying in a nursing home.
Researchers also found that compared with community-dwelling patients, those in nursing homes included a higher percentage of individuals dually eligible for Medicare and Medicaid at 30.4% compared to 17.1% of community residents.
Individuals living in nursing homes also had a higher likelihood of at least five comorbid conditions at 75.5% compared to 48.8%. Conversely, the percentage of patients with high case-fatality cancers was higher among the community-dwelling group than among nursing home residents.
“Interventions to decrease aggressive EOL care should target the main factors associated with its prevalence.” researchers wrote.
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