The metric matters: Comparing end-of-life (EOL) systemic anticancer therapy use (SACT) in two quality indicators.

307 Background: Cancer care quality metrics are increasingly used to evaluate effective care, inform public reporting, and determine reimbursement. While current guidelines recommend discontinuing SACT at EOL, measure definitions differ across organizations. We compared two EOL SACT metrics to gain a deeper understanding of their performance. Methods: We studied two EOL SACT use definitions from: 1) ASCO, endorsed by NQF and used by CMS, and 2) Vizient, a benchmarking organization used by > 1200 health systems and 97% of academic centers. We calculated institutional EOL SACT use and patient characteristics based on both definitions. Results: ASCO and Vizient both define EOL SACT as the proportion of patients with cancer who receive inpatient(IP)/outpatient(OP) therapy within 14 days of death. ASCO’s numerator includes both IP and OP deaths; Vizient includes IP deaths. For the denominator, ASCO requires death from cancer and ≥2 encounters from the reporting site while Vizient requires ≥1 cancer encounter. ASCO reports an overall rate, with an average of 10.7% in CMS MIPS (2024). Conversely, Vizient assigns separate scores to 24 anatomically grouped subservice lines. These scores are weighted equally and ranked among the 114 oncology hospitals. ASCO defines SACT as chemotherapy (CT), immunotherapy (IO), biologics, and targeted therapies (TT). 256 unique drugs meet this definition, of which 36% are CT, 17% IO, and 46% TT. Vizient has 150 drugs with specified formulations, of which 47% are CT, 17% IO, 28% TT, 5% hormones, and 2% ancillary. From 1/2023 to 12/2024, EOL SACT use institutionally was 6.4% (698/10872 deaths) per ASCO and 0.12% (346/281803 patients) per Vizient. Half of ASCO deaths were in hematologic cancers versus 63.6% of deaths in Vizient. All Vizient deaths were inpatient while 56.2% of ASCO deaths were inpatient. Both cohorts had similar mean death age (ASCO: 61.7 vs Vizient 60.1, p = 0.11). Conclusions: Although ASCO and Vizient both measure EOL SACT, methodological differences in patient inclusion, encounter requirements, drug scope, and weighting result in substantially different EOL outcomes. These methodological differences can impact reported outcomes, potentially influencing quality rankings, reimbursement, and improvement priorities. Methodology ASCO Definition Vizient Definition Numerator # of pts w/ IP/OP SACT within 14 days of IP/OP death # of pts w/ IP/OP SACT within 14 days of IP death Denominator # of pts who died from cancer and ≥2 encounters at reporting site # of pts w/ ≥1 cancer encounter Drugs 256 drugs: 36% CT, 17% IO, 46% TT 150 drugs with prespecified formulations: 47% CT, 17% IO, 28% TT MD Anderson Outcomes End of Life SACT Use 698/10872 (6.4%) 346/281803 (0.12%) Tumor Type 50.0% solid cancers50.0% hematologic cancers 36.4% solid cancers63.6% hematologic cancers Inpatient Deaths 56.2% 100% Death Age (Mean, SD) 61.7 (15.7) 60.1 (15.5)