Conclusions and policy implications
Our results suggest that less use of palliative chemotherapy
among patients recognized to have a life expectancy of six
months or less—or more frequent end of life discussions in this
group—may reduce intensive end of life care and promote earlier
access to hospice services, thus improving the quality of
advanced cancer patients’ end of life care. Future studies should
determine the mechanisms by which palliative chemotherapy
is associated with increased risk of receiving intensive care at
the end of life and dying in an intensive care unit and examine
explicitly whether palliative chemotherapy is associated with
patients’ goal attainment.
Our study has important implications for oncology providers,
patients with advanced cancer, and caregivers facing decisions
about treatment. It suggests that end of life discussions may be
particularly important for patients receiving palliative
chemotherapy, who should be informed by data on the likely
outcomes associated with its use. The findings also suggest the
need for oncology providers to elicit patients’ preferred site of
death to ensure that patients’ end of life experiences are
congruent with their values.