For people with terminal cancer, the last stage of life is deeply personal. Some patients may choose to continue cancer treatment, hoping for more time, while others may prefer to stop treatment and focus on comfort.

But according to a study from Rutgers Health, what a patient wants doesn’t always determine what actually happens. Instead, the choice often depends on their doctor’s usual approach to end-of-life care.

The study, published in the journal Cancer, looked at how oncologists (cancer doctors) treat patients in their final days. Researchers found that some doctors are much more likely than others to continue chemotherapy and other cancer treatments, even when guidelines suggest stopping.

This means a patient’s final weeks may be shaped more by their doctor’s habits than by their own preferences.

When Cancer Treatment May Do More Harm Than Good

For many types of cancer, medical experts recommend stopping chemotherapy near the end of life. This is because, in the final weeks, aggressive treatment can cause more harm than benefit. It may lead to serious side effects, lower quality of life, and even shorten the patient’s remaining time.

Instead, doctors are encouraged to have conversations with patients about their goals and consider hospice care, which focuses on comfort rather than curing the disease.

However, the Rutgers study suggests that these decisions are not always based on what’s best for the patient. Instead, some oncologists tend to continue treatment out of habit, while others are more likely to stop it.

The Study: How Much Does Your Doctor’s Habit Matter?

To understand this better, the researchers analyzed national health data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program.

They looked at Medicare billing records for 17,609 patients who died from breast, lung, colon, or prostate cancer between 2012 and 2017. These patients had been treated by 960 different oncologists across 388 clinics and hospitals.

The researchers categorized doctors based on their tendency to prescribe chemotherapy or other cancer treatments in the last two weeks of a patient’s life. Some doctors prescribed treatment to a high percentage of their dying patients, while others rarely did so.

The results were striking: Patients whose oncologists had a high prescribing tendency were 4.5 times more likely to receive cancer treatment in their final days compared to those treated by low-prescribing doctors.

This means that two patients with the same type of cancer could have very different experiences—one might continue receiving chemotherapy until the end, while the other might stop treatment earlier—simply because of their doctor’s usual practice.

Who Is More Likely to Receive Late-Stage Treatment?

The study also found that some groups of patients were more likely than others to receive cancer treatment near the end of life:

• Breast cancer patients were more likely to receive late-stage treatment compared to lung cancer patients.
• Colon and prostate cancer patients had about the same likelihood of receiving late treatment as lung cancer patients.
• Black patients were less likely than white patients to receive treatment in the last month of life.
• Unmarried patients (single, divorced, or widowed) were less likely to receive late-stage treatment than married patients.

Because the data was anonymous, researchers couldn’t see which specific doctors or hospitals were prescribing the most end-of-life treatments. However, the findings highlight significant differences in how patients are treated based on their doctor’s usual approach.

Why This Matters for Patients and Families

This study raises important questions about patient choice in end-of-life care. Ideally, treatment decisions should be made based on a patient’s wishes and medical needs. But in reality, they are sometimes shaped by factors outside of the patient’s control.

Lead researcher Login S. George, a health services expert at Rutgers, suggests that making this kind of information public could help patients make better choices about their care.

“When we choose a restaurant or a product, we often look at reviews before deciding,” George said. “Shouldn’t patients with cancer have the same ability to choose a doctor whose treatment approach matches their wishes?”

Moving forward, the researchers plan to explore why some doctors continue aggressive treatment while others do not. They also want to study how patients and their families make decisions between continuing cancer treatment and choosing hospice care.

Review and Analysis

This study highlights a major issue in cancer care: the decisions made at the end of life don’t always reflect what patients want. While guidelines suggest stopping aggressive treatments in the final days, some doctors continue them at much higher rates than others. This raises concerns about whether patients truly have control over their care.

The fact that a patient’s treatment depends so much on their oncologist’s habits suggests that more transparency is needed in healthcare. If patients had access to information about different doctors’ prescribing tendencies, they could choose a provider who aligns with their own preferences.

The study also revealed disparities in treatment based on race and marital status, showing that not all patients receive equal care. Future research could help explain why these differences exist and how they might be addressed.

In the end, this research emphasizes the importance of open conversations between doctors and patients about end-of-life care. Patients deserve to make informed choices about their treatment, and doctors should ensure that those choices are respected.

The research findings can be found in Cancer.

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