At End of Life, Chemotherapy Use Dropped After Implementation of Medicare Reform Act

Tony Berberabe, MPH @OncBiz_Wiz
Published: Tuesday, May 13, 2014

The reductions in reimbursement for chemotherapy drugs after passage of the Medical Modernization Act (MMA) had a distinct effect on the administration of cancer drugs for patients in the last 14 days of life, according to a study from the Norris Cotton Cancer Center.

Carrie H. Colla, PhD, and colleagues found that the use of chemotherapy at the end of life fell 20% after MMA implementation. In addition, the researchers found no concurrent change in chemotherapy use in hospital outpatient departments.

The results suggest that payment reform may be used to better align appropriate financial incentives with better quality of care. The researchers note that “near the end of life, aggressive anticancer therapies may prove to be more toxic than beneficial, their use may not be related to probability of providing benefit, and appropriately timed cessation of chemotherapy is integral to a patient’s quality of life.”

Colla, et al, compared pre- and post-reform probability and frequency of chemotherapy receipt in patients in the last 14 days of life, and reviewed changes in chemotherapy use in physician offices and hospital outpatient departments. Before the MMA implementation, from 2003 to 2004, 18% of patients in physician offices received chemotherapy in the last 14 days of life. Patients who died after implementation of the MMA, from 2006 to 2007, were 3.5 percentage points, or 20%, less likely to receive chemotherapy during the last 14 days of life.

The authors note that previous studies examined responses to the MMA in chemotherapy use in newly diagnosed patients, but provided little evidence to determine whether treatment changes improved or degraded quality of life.

The researchers suggest that the disparity between office and hospital outpatient administration of chemotherapy may be attributed to physicians having no direct incentive to order chemotherapy of marginal benefit in hospitals. They point out that if the decrease in chemotherapy use during end-of-life situations were driven by broad trends such as diffusion of quality standards by oncology groups, the increasing acceptance of palliative care, or the introduction of new drugs, equivalent changes would be evident in both settings.


J Oncol Pract. 2012 May;8(3 Suppl):e6s-e13s

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