Overuse of diagnostic, therapeutic, and consultative services among hospitalized patients approaching the end of life.

Abstract

e23093 Background: Patients with cancer approaching the end of life (EOL) often undergo multiple diagnostic and therapeutic interventions, many of which do not contribute to improved patient outcomes or quality of life, and may cause unintended harm. Hospitalizations at the EOL are associated with costly and aggressive treatment. This study aims to evaluate the extent of overuse of procedures among hospitalized patients with cancer and identify factors contributing to non-beneficial care at the end of life. Methods: A retrospective cohort study was conducted at Columbia University from May 1, 2023 to June 30, 2024. We included patients with cancer age 18 or older who died during or within 14 days of hospitalization on the solid tumor oncology service. Data were collected on interventions received during the final hospitalization of life, including laboratory tests, imaging studies, intravenous chemotherapy, parenteral nutrition, subspecialist consultations, and documentation of advanced directives. Overuse was defined as interventions that did not result in clinically meaningful benefit or direct changes in management. Descriptive statistics were used to report frequencies of interventions, while [bivariate analyses assessed associations with patient characteristics (e.g., cancer type, age, performance status)]. Results: A total of 261 patients with cancer were included in the study. On average, patients received multiple and often repetitive interventions in the final two weeks of life. In total the cohort underwent 101,452 individual laboratory tests (maximum tests for an individual during a 14-day period = 2769); the mean, was 21.5 laboratory tests per-day (maximum 128 tests per day). A total of 16 patients (6.1%) received chemotherapy during their hospitalization and 15 (5.7%) received parenteral nutrition. Specialist consultations (excluding Palliative Care) were requested for 202 patients(77.0%, maximum unique consultations 10). Conclusions: Diagnostic, therapeutic, and consultative overuse is common in the final two weeks of life for hospitalized patients with cancer. These interventions, often not aligned with end-of-life care goals, may contribute to patient distress without improving outcomes. There is a need for clearer guidelines and directed clinician education on appropriate scope and frequency of interventions during hospitalizations at the EOL for patients with advanced malignancy.