Background: Aggressive medical care at the end of life is widely recognized to be harmful to cancer patients. This includes cancer-directed procedures and therapies; emergency room and ICU admissions; and in-hospital deaths. Prevalence of its use in patients younger than 65 has not been previously examined. We evaluated use of aggressive care within the last 30 days of life from before to after ASCO’s 2012 Choosing Wisely campaign aimed at reducing aggressive end-of-life care. Methods: Claims data from the HealthCore Integrated Research Database were analyzed, which overall includes ~60 million individuals enrolled in Blue Cross and/or Blue Shield licensed plans across 14 states. Patients aged ≤ 65 who died between 2007-2014 and who had diagnoses for metastatic lung, colorectal, breast, pancreatic, and prostate cancers were included. Poisson multivariable regression models assessed the associations between age group, geographic region, gender, and regional education and income measures with aggressive care. Results: 28,731 patients were analyzed. 71-76% of patients across different cancers received aggressive care within the last 30 days of life (Table), including 30-35% of patients who died in the hospital. Rates of aggressive care use between early 2012 before Choosing Wisely vs. 2014 were unchanged in patients with colorectal and breast cancers; and increased in lung, pancreatic and prostate cancers. On the other hand, hospice use ranged from 14-18% across cancers. Multivariable models showed regional variations in aggressive care and hospice use. Conclusions: There is substantial overuse of aggressive end-of-life care among younger patients with incurable cancers. Aggressive care did not decrease following the 2012 ASCO Choosing Wisely recommendations.