For terminally ill cancer patients, the decision to continue or cease treatment is a deeply personal one. However, a study by Rutgers Health published in the journal Cancer suggests that these decisions are often influenced more by oncologists than by patients’ wishes.
“A patient’s end of life is often not a reflection of what they want, but rather, who their oncologist happens to be,” stated Login S. George, lead author of the study and health services researcher at the Rutgers Institute for Health, Health Care Policy and Aging Research. He further noted that “the data doesn’t indicate patient-centered treatment decisions, but rather, more habitual or default ways of treating patients.”
The study highlights that clinical guidelines recommend stopping chemotherapy in the final days as it may cause more harm than benefit. Despite this, oncologists might base their decisions on established practices rather than individual patient preferences.
George and his team analyzed data from 17,609 cancer patients who died between 2012 and 2017 using information from Medicare hospital outpatient and carrier claims. They focused on breast, lung, colorectal, or prostate cancer cases treated by 960 oncologists across 388 practices.
Their analysis revealed significant differences in prescribing behaviors among oncologists. Patients treated by high-prescribing oncologists were found to have a 4.5-times higher likelihood of receiving treatment in their final days compared to those under low-prescribing doctors.
Additionally, findings showed disparities based on cancer type and demographics: breast cancer patients had higher odds of late-stage treatment compared to lung cancer patients; Black patients were less likely to receive last-month treatments than white patients; unmarried individuals also had lower odds compared to married ones.
Although specific identities of prescribing oncologists could not be determined due to anonymized data, George emphasized the importance of transparency in aligning patient care with personal wishes: “Shouldn’t patients with cancer have the same luxury?” he asked regarding informed choices about healthcare providers.
The research received support from both the Rutgers Cancer Institute and the National Cancer Institute. Co-authors included Paul R. Duberstein from Rutgers School of Public Health and several others affiliated with Rutgers University.
Future research aims to explore factors influencing decisions between continuing aggressive treatments versus opting for hospice care at life’s end.
