Quality of death in cancer: no treatment versus late chemotherapy in a nationwide mortality follow-back study.

OBJECTIVES

To examine differences in quality of dying (QOD) between patients with cancer receiving no anticancer treatment (untreated group) and those receiving chemotherapy in the last 3 months of life (late chemotherapy group), and to explore socioeconomic characteristics by treatment status.

METHODS

This observational study used data from a Japanese nationwide mortality follow-back survey, restricted to cancer decedents. Questionnaires were mailed to their bereaved family members. The primary outcome was family-reported QOD, and the exploratory outcomes included symptom burden, end-of-life (EOL) discussions and socioeconomic factors. Analyses were stratified by age (<60, 60-79, ≥80 years).

RESULTS

Of 48 124 eligible responses, 12 563 were untreated. The proportion untreated increased with age (4.9%<60 years, 42.4% ≥80 years). Untreated patients had shorter survival times and more hepatobiliary or pancreatic cancer. The QOD was not poorer in untreated patients. Of untreated patients <60 years, 42.9% were free from physical distress versus 28.9% in the late chemotherapy group (difference: 14.0 points; 95% CI 5.5 to 22.5). Among untreated patients aged 60-79 years, 51.0% reported life completion versus 41.7% in the late chemotherapy group (difference: 9.3 points; 95% CI 6.9 to 11.7). More families of untreated patients reported EOL discussions with their physicians. Younger, untreated patients were more likely to be from lower-income households.

CONCLUSION

The absence of anticancer treatment was not associated with a poorer QOD in untreated patients. Socioeconomic disparities among younger patients highlight the need for equitable access to cancer care and support for value-based EOL decision-making.