The low quality of life and a higher economic burden is associated with high-intensity care with undue suffering at the end of life (EOL). For a better quality of life of patients nearing death, healthcare delivery needs to focus on pain and symptom management instead of prolonging life.

The pattern and predictors of high-intensity care among patients with GI cancer in Puerto Rico were studied to understand the same. Being a population-based study, the patient who suffered from GI cancer and died between 2009 and 2017 was considered.

4629 patients were included in the study, and the results found that 11.0% of patients received chemotherapy, 17.3% had > 1 hospitalization, 9.3% were in the ICU, 18.0% had > 1 ER visit, 39.3% died in an acute care setting, and 8.6% received life-extending procedures. Also, 54.5% of patients had at least one of the selected aggressive indicators.

Aggressive EoL care was observed in 73.5% of patients enrolled within the last three days before death, 31.5% enrolled within 3 to 30 days, and 11.1% enrolled more than 30 days before death.

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The overall research suggested that the GI cancer patients’ near-death EoL care in Puerto Rico requires urgent improvement focusing on the personal, family, community, provider, and health system factors.

Initiatives to multiply palliative medicine specialists and improve palliative care training among healthcare providers for better EoL care needs to be taken.