A new study published in Cancer reveals that advanced cancer patients with implantable cardioverter defibrillators (ICDs) are more likely to receive aggressive end-of-life care compared to those without the cardiac devices, raising important questions about care coordination and planning.
The retrospective analysis, led by researchers at UT Southwestern Medical Center, examined Medicare claims data linked to SEER cancer registry records from 2005-2015. The study included 37,306 patients with stage III or IV breast, colorectal, or pancreatic cancers, of whom 2,117 (6%) had ICDs.
Key Findings and Statistical Evidence
The research revealed striking differences in end-of-life care patterns. ICD users faced higher odds of aggressive interventions in their final month of life, including:
- Multiple emergency department visits (OR 1.16; 95% CI, 1.01–1.32)
- Multiple hospitalizations (OR 1.20; 95% CI, 1.03–1.39)
- Intensive care unit stays (OR 1.17; 95% CI, 1.06–1.30)
- Hospital deaths (OR 1.27; 95% CI, 1.15–1.40)
- Invasive procedures (OR 1.23; 95% CI, 1.22-1.36)
Patient Demographics and Device Timing
Among ICD users, 63% had their devices implanted before their cancer diagnosis. The median time from first ICD claim to death was 35.7 months. The patient population was predominantly female (55%) and non-Hispanic White (83%), with a median age of 79 years for ICD users compared to 76 years for non-users.
Opportunities for Care Integration
Notably, 45% of ICD patients had device programming or interrogation visits near the end of life, with an additional 26% having monitoring visits. Dr. Megan Mullins, the study's lead author and assistant professor at UT Southwestern Medical Center, emphasized these encounters as crucial opportunities for discussing care goals.
"Many people who have cancer are also dealing with other medical problems concurrently, including heart arrhythmias," said Dr. Mullins. "By putting these heart devices on cancer specialists' radars, we can help them start having conversations with patients to ensure their end-of-life care matches their stated wishes."
Clinical Implications
The findings underscore the importance of coordinated care between oncology and cardiology teams. Healthcare providers caring for terminal cancer patients with ICDs should proactively address device management, including potential deactivation discussions, as part of comprehensive end-of-life care planning.
The study's results suggest a need for enhanced communication between specialists and more integrated approaches to managing complex medical devices in the context of terminal cancer care. Future research will continue to explore the relationship between ICD prevalence and aggressive end-of-life care patterns.
