Rethinking systemic anti-cancer therapy in the last 14 days of life in the era of oral oncology.

466 Background: End-of-life (EOL) cancer care is often evaluated using metrics such as systemic anti-cancer therapy (SACT) administration in the last 14 days of life (CL14D). The growing use of oral oncology therapies introduces new complexities in measuring CL14D. Oral treatments involve distinct prescribing pathways that challenge traditional definitions and may not fully capture factors like self-administration, dispense dates, days’ supply, adherence, automatic refills, treatment intensity, and associated costs. This study examines the contributors to CL14D and the impact of expanding oral therapy options on its measurement. Methods: We conducted a retrospective analysis using claims and episode data from the Medicare Enhancing Oncology Model (EOM) program, covering a large, multi-state, community-based oncology network from July 2023 to June 2024. CL14D was analyzed by route of administration—injectable vs. oral—alongside demographic and disease characteristics. Associations between treatment patterns, healthcare utilization and measure results were then assessed. Results: Among patients who died during the episode, 21.4% had SACT claims in the last 14 days of life. Of these, 25% had oral SACT claims (dispenses), and 7.5% had both oral and injectable SACT claims. An additional 7% had oral SACT claims with a days’ supply extending into the last 14 days (used as a proxy for self-administration of oral drug by the patient). 98% of oral SACT claims were for a 28-day or 30-day supply. 50% of oral SACT claims were refills of prior dispenses. Half of the deceased patients had oral SACT claims in the last 30 days of life, and for 5%, this marked the initiation of the oral agent. CL14D accounted for 10.3% of total cost of care for deceased patients, with 2.7% from oral SACT. Oral SACT represented 26.8% of SACT spending in the last 14 days, and 5.9% of total costs were linked to claims with days’ supply within this period. Hospice enrollment for ≥3 days prior to death was observed in 55.1% of patients without CL14D, compared to 16.1% receiving injectable and 11.1% receiving oral SACT in the last 14 days. Conclusions: The rise of oral oncology therapies is reshaping EOL SACT use, with significant implications for treatment intensity, outcomes, and healthcare resource use. Traditional metrics like CL14D may need to be updated to encompass the nuances of oral therapies, such as dispenses without patient initiating therapy, patient adherence, auto-refills of prescriptions, etc. Lower hospice enrollment among patients receiving CL14D suggests that existing benchmarks may need to be updated to capture evolving care dynamics. Future research should focus on developing refined indicators that balance ongoing treatment with quality-of-life considerations to better assess EOL care.