For patients with metastatic or advanced cancer, treatment at practices with higher rates of National Quality Forum (NQF) 0210 (patients receiving chemotherapy in the last 14 days of life) is not associated with improved survival, according to a study published online May 16 in JAMA Oncology.

Maureen E. Canavan, Ph.D., from the Yale School of Medicine in New Haven, Connecticut, and colleagues examined survival among patients with metastatic cancer in a study involving 78,446 adults with one of six common cancers (breast cancer, colorectal cancer, non-small cell lung cancer [NSCLC], pancreatic cancer, renal cell carcinoma, and urothelial cancer). Practices were stratified into quintiles based on the rates of NQF 0210; overall survival was compared by disease type among all patients treated in each practice quintile.

There was variation observed in the practice-level NQF 0210 rates, from 10.9 to 32.3 percent (quintiles 1 and 5, respectively) for NSCLC and from 6.8 to 28.4 (quintiles 1 and 5, respectively) for colorectal cancer. The researchers found that survival did not differ significantly for patients treated at the highest and lowest NQF 0210 quintiles. The hazard ratio for death among patients seen at practices with the highest versus the lowest NQF 0210 quintiles varied from 0.74 (95 percent confidence interval, 0.55 to 0.99) to 1.41 (95 percent confidence interval, 0.98 to 2.02) for those with renal cell carcinoma and urothelial cancer, respectively. After applying the Bonferroni correction, these differences were not statistically significant.

“Our study highlights the importance of open and honest communication about prognosis between providers and patients,” senior author Kerin Adelson, M.D., of the University of Texas MD Anderson Cancer Center in Houston, said in a statement. “Our findings may help oncologists reconsider treatment and instead provide patients with transparent information on supportive care options so they are able to make informed decisions.”

Several authors disclosed ties to the pharmaceutical industry; the study was funded by Flatiron Health, which is an independent member of the Roche group.

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