END-OF-LIFE AGGRESSIVE CARE AND ITS INFLUENCING FACTORS AMONG LUNG CANCER PATIENTS IN CHINA: A REAL-WORLD STUDY BASED ON DATA FROM CITY A
Author(s)
zixuan lyu1, Jingyi Hu, Bachelor1, Yue-hua Liu, PhD2, Jian Wang, phD1;
1Wuhan university, wuhan, China, 2Wuhan university, Beijing, China
1Wuhan university, wuhan, China, 2Wuhan university, Beijing, China
OBJECTIVES: Lung cancer is a leading cause of mortality in China. Aggressive end-of-life (EOL) care—defined as systemic therapy within 14 days of death—often increases financial and physical burdens without extending survival. This study evaluates the prevalence, economic impact, and drivers of EOL aggressive care using a Chinese municipal medical insurance database.
METHODS: We identified 2,112 lung cancer decedents (2018-2024). Aggressive care included chemotherapy, targeted therapy, or immunotherapy within 14 days of death. Costs were CPI-adjusted to 2025 levels. Using 1:2 propensity score matching (PSM), we analyzed 12-month cost trajectories and employed Firth penalized logistic regression to identify influencing factors.
RESULTS: Of the 2,112 decedents, 198 (9.4%) received EOL aggressive care. Groups were comparable at baseline (≈70% male; >80% employee insurance). Aggressive care was linked to significantly higher median total, out-of-pocket, and pharmaceutical costs, particularly for targeted therapy, immunotherapy, and chemotherapy (TIC) and radiology. Cost trajectories diverged sharply three months pre-death; in the final month, the aggressive group’s median total costs reached CNY 120,000—over double the non-aggressive group. Firth regression revealed no significant associations (P > 0.05) between aggressive care and demographic, insurance, or comorbidity factors, indicating a highly non-selective treatment pattern.
CONCLUSIONS: EOL aggressive care in this region is homogeneous and independent of socioeconomic or clinical profiles, suggesting entrenched treatment norms rather than patient-centered benefits. Policy interventions should prioritize early palliative care, ideally three months before death, and promote value-based decision-making to reduce wasteful spending and protect terminal patient dignity.
METHODS: We identified 2,112 lung cancer decedents (2018-2024). Aggressive care included chemotherapy, targeted therapy, or immunotherapy within 14 days of death. Costs were CPI-adjusted to 2025 levels. Using 1:2 propensity score matching (PSM), we analyzed 12-month cost trajectories and employed Firth penalized logistic regression to identify influencing factors.
RESULTS: Of the 2,112 decedents, 198 (9.4%) received EOL aggressive care. Groups were comparable at baseline (≈70% male; >80% employee insurance). Aggressive care was linked to significantly higher median total, out-of-pocket, and pharmaceutical costs, particularly for targeted therapy, immunotherapy, and chemotherapy (TIC) and radiology. Cost trajectories diverged sharply three months pre-death; in the final month, the aggressive group’s median total costs reached CNY 120,000—over double the non-aggressive group. Firth regression revealed no significant associations (P > 0.05) between aggressive care and demographic, insurance, or comorbidity factors, indicating a highly non-selective treatment pattern.
CONCLUSIONS: EOL aggressive care in this region is homogeneous and independent of socioeconomic or clinical profiles, suggesting entrenched treatment norms rather than patient-centered benefits. Policy interventions should prioritize early palliative care, ideally three months before death, and promote value-based decision-making to reduce wasteful spending and protect terminal patient dignity.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
RWD161
Topic
Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Oncology