Academic oncologists’ attitudes and practices regarding the care of cancer patients at the end of life
8572 Background: Despite the fact that cancer is the second leading cause of death in the US and represents the most frequent diagnosis among hospice patients, little is known about the factors that influence oncologists in their decision making around end of life care. Methods: We surveyed all clinically active medical oncology attending and fellow physicians at two affiliated academic medical centers eliciting oncologists’ attitudes and practices regarding care of cancer patients at the end of life. Included in the survey were a series of randomized vignettes describing patients with advanced solid tumors. Oncologists were asked to describe their next treatment recommendations. Results: Of the 181 oncologists contacted for survey participation, 116 (64%) returned completed questionnaires. Sixty six percent (77/116) of respondents were attending physicians and 34% (39/116) were fellows. Sixty-five percent favored concurrent treatment with third-line chemotherapy and hospice if insurance would allow. Eighty percent (93/116) agreed that patients with advanced cancer should be able to receive hospice care even if they are receiving anti-tumor therapies. Results of randomized scenarios suggest that advanced patient age was positively associated with earlier referral to hospice care and that prior treatment on a clinical trial, although not statistically significant, was modestly associated with delayed referral to hospice (1.49, 95% CI 0.71–3.11). Conclusions: Among oncologists at two academic centers, chemotherapy is an important modality for management of advanced cancer patients at the end of life. Therefore, insurance policies that prohibit chemotherapy for hospice patients may constrain oncologists in their management of such patients. No significant financial relationships to disclose.