Recent studies spanning various countries have found that location matters for patients with cancer and opioid disorders when it comes to end-of-life care delivery, costs and outcomes.

Understanding the significant factors driving global data disparity trends can help inform hospices’ service development strategies and care models. Data has become key to helping providers learn where potential pitfalls and opportunities may exist.

Opioid use associated with end-of-life disparities

Adults with opioid use disorder (OUD) face greater gaps around end-of-life support, according to a recent study published in the Canadian Medical Association Journal.

Researchers scoured patient data of nearly 680,000 decedents in Ontario, Canada who died between July 1, 2015 and Dec. 31, 2021. About 11,200 decedents, or 1.6%, had some type of opioid use disorder.

Individuals with opioid disorders were 16% less likely to receive end-of-life care during the last 90 days of life compared to others, the study found. Settings examined included acute care hospitals, health care clinics, long-term care facilities and the home.

“Stigma toward people who have substance use disorders can contribute to late referrals and missed opportunities,” the researchers wrote in the study. “People with OUD are more likely to experience structural vulnerability than the general population.”

Of the individuals with an OUD, nearly a third (28.8%) had an emergency department visit or a hospitalization near the end of life related to the disorder. Adults with opioid disorders were also more likely to live in low-income areas, at 37.9% of OUD decedents in these regions compared to 25.2% among others.

The findings suggest that people with substance use disorders often have more complicated and costly end-of-life trajectories, with several socioeconomic and practical barriers to improved quality, according to the researchers. More training is needed to move the needle, they stated.

“Our study demonstrated that the known socioeconomic inequities experienced by people living with OUD persist until the end of their lives,” the researchers stated. “Health care providers should receive training in palliative care and addiction medicine to provide equitable end-of-life care for people with OUD and other substance use disorders.”

Nearly two decades of blood cancer patient mortality data revealed

A growing number of blood cancer patients are dying in community-based settings and receiving hospice care at the end of life

This is according to a recently released analysis spanning nearly two decades of electronic medical record data from the U.S. Centers for Disease Control and Prevention’s (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) database.

Researchers from Michigan-based Corewell Health examined hospice utilization and place of death from 2003 to 2020 among patients with multiple myeloma (MM), a type of hematological cancer. More patients with this type of blood cancer are choosing to use hospice services at the end of life, the analysis found.

“Over the past two decades, there has been a trend in increased utilization of hospice facilities in end-of-life care among MM patients,” researchers wrote in the analysis. “Place of death (POD) is an important determinant of patient and caregiver preference, access to home-based supportive care and cost of caregiving at [the end-of-life (EOL)].”

Nearly 43% of blood cancer patients died receiving care in their home or at an inpatient hospice facility, with this volume increasing annually during the examined time period, the analysis found. This compared to more than half (52.12%) patient deaths that occurred in skilled nursing or medical facilities, with these settings seeing a decline in deaths over the years.

The findings point to the significance of caregiver support when it comes to end-of-life outcomes, the researchers indicated. Individuals without sufficient caregiver resources lack the ability to age in place, which can impact the ability for them to receive hospice at home, they indicated.

The analysis also found race and ethnicity among the factors impacting hospice disparities, which mirrors national utilization trends. Roughly 45% of white patients utilized hospice services at the end of life, a larger cohort when compared to rates among minority groups such as African Americans, Asians and Pacific Islanders, Alaska Natives or American Indians.

“There [are] still opportunities to expand [hospice care] utility, especially in north-east and among African American patients to reduce the psychological and cost of end-of-life care,” the researchers stated.

End-of-life care saves cancer costs

A new cancer quality metric has been developed by the American Society of Clinical Oncology and the National Quality Forum (NQF). Dubbed NQF 0210, the metric measures outcomes among cancer patients receiving chemotherapy within the last 14 days of life and is aimed at reducing systemic anticancer therapy administration at the end of life.

The quality metric was in part fueled by a study spanning a national database of 78,446 adult cancer patients receiving chemotherapy services across 144 clinical practices, which was recently published in the Journal of the American Medical Association (JAMA) Network. Using the NQF 0210 measure, researchers found no statistical differences in survival rates among cancer decedents treated with more aggressive treatments compared to others.

“In seeing no improvements in survival among practices with highest rates of treatment for very advanced disease, oncologists may hesitate before offering additional therapy and focus on open and honest communication about prognosis, allowing patients to make informed decisions,” the researchers noted in the study.

The findings suggest that the health care system at large is spending too much on expensive, aggressive cancer treatments that will ultimately not prolong a patient’s life, according to the researchers. Beyond the financial impacts to consider are also the quality outcomes, they added.

More education is needed when it comes to assessing patients’ terminal conditions alongside their goals of care, as well as greater awareness around hospice, the researchers stated.

“Future efforts should focus on helping oncologists identify when additional therapy is futile, developing goals of care communication skills, and aligning payment incentives with improved end-of-life care,” researchers stated.

Breast cancer patients find symptom relief at end-of-life

Terminally ill breast cancer patients could benefit from receiving palliative care treatments at the end of life, according to recent research.

Utilization of multidisciplinary palliative care toward the end of life was found to alleviate breast cancer patients’ suffering and improve their quality of life in a recent study published in Cureus.

Researchers examined medical record data of breast cancer patients admitted to the palliative care unit at the Kashiwara Municipal Hospital in Japan between October 2017 and December 2023. The findings point to a greater need to expand education and utilization around interdisciplinary care toward the end of life versus costly, invasive procedures, the researchers indicated.

“The target of palliative treatments is to relieve symptoms and avoid radically curing these clinical conditions,” the researchers stated in the study. “The information shared will contribute to the clinical dialogue and knowledge of treating terminally ill patients suffering from breast cancer.”

Rising demand represents a large propeller pushing more cancer research to the forefront in an effort to understand the most impactful care models, including hospice and palliative care.

Breast cancer is the second leading cause of death in women in the United States, reported the American Cancer Society.

Breast cancer patients can develop a range of severe medical conditions as their illness progresses that can lead them to seek palliative treatments, sedations and surgeries aimed at easing their pain and symptoms, according to the researchers.

“Palliative treatments using appropriate infusion, narcotics, oxygen administration, various drugs and sedation were administered in our palliative care unit to relieve symptoms instead of radical treatments for severe clinical conditions of breast cancer,” researchers stated.