Background: All patients with cancer deserve quality end-of-life (EOL) care.Despite established EOL quality metrics, many patients with cancer receive futile, aggressive EOL care with infrequent palliative care involvement and advanced care planning (ACP) documentation. Clinical trials are critical to advancing cancer care; at National Cancer Institute-designated cancer centers, ~20% of patients participate in clinical trials at some point. We aim to identify associations between trial enrollment in the last year of life (YOL) and EOL quality metrics for adults with solid or hematologic malignancies to identify opportunities to advance cancer care near death. Methods: This is a retrospective review of patients with solid or hematologic cancers treated at a single academic institution who died of disease between 2018 – 2022. Patients were identified using institutional registries. Inclusion criteria were ≥18 years of age with active disease at death. Outcomes include: initiation of new anti-cancer therapy, Intensive Care Unit (ICU) admission, hospitalization, or Emergency Department (ED) visit in the last 30 days of life (DOL), referral to hospice, palliative care involvement, and documentation of goals of care (GOC) and ACP paperwork. Results: Among 9,384 patients, 637 (6.8%) enrolled in clinical trials in the last YOL. Most common disease sites were gastrointestinal, thoracic, and genitourinary. Patients enrolled in clinical trials were more likely to initiate new anti-cancer treatments in the last 30 DOL (p=<0.001), less likely to be referred to palliative care (p=0.008) or have GOC documentation (p=<0.001), and less likely to visit the ED (p=0.016) or die in an inpatient setting (p=0.02). No differences were noted in referrals to hospice, ICU or hospital admissions in last 30 DOL, or ACP paperwork. Conclusions: Enrollment in a clinical trial in the last YOL was associated with several measures of aggressive EOL care. Low rates of palliative care and hospice engagement and infrequent documentation of ACP decisions across the study population suggest opportunities for improvement for all patients, regardless of trial enrollment.

DOL, days of life; ED, emergency department; ICU, intensive care unit; GOC, goals of care; ACP, advanced care planning.