TY - JOUR
T1 - Trends in end-of-life cancer care in the Medicare program
AU - Wang, Shi Yi
AU - Hall, Jane
AU - Pollack, Craig E.
AU - Adelson, Kerin
AU - Bradley, Elizabeth H.
AU - Long, Jessica B.
AU - Gross, Cary P.
N1 - Funding Information:
The collection of the California cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute's Surveillance, Epidemiology and End Results Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N02-PC-15105 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention's National Program of Cancer Registries, under agreement #U55/CCR921930-02 awarded to the Public Health Institute. The authors of this report are responsible for its content. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. The interpretation and reporting of the SEER-Medicare data are the sole responsibility of the authors.
Funding Information:
This investigation was supported by a Pilot Grant and a P30 Cancer Center Support Grant (CCSG), both from Yale Comprehensive Cancer Center. Dr. Pollack is supported by a career development award from the National Cancer Institute and the Office of Behavioral and Social Science Research ( 1K07CA151910 ). Dr. Wang is supported by a career development award from the Agency for Healthcare Research and Quality ( 1K01HS023900 ).
Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Objectives: To examine contemporary trends in end-of-life cancer care and geographic variation of end-of-life care aggressiveness among Medicare beneficiaries. Materials and Methods: Using the Surveillance, Epidemiology, and End Results-Medicare data, we identified 132,051 beneficiaries who died as a result of cancer in 2006-2011. Aggressiveness of end-of-life care was measured by chemotherapy received within 14 days of death, >. 1 emergency department (ED) visit within 30 days of death, >. 1 hospitalization within 30 days of death, ≥. 1 intensive care unit (ICU) admission within 30 days of death, in-hospital death, or hospice enrollment ≤. 3 days before death. Using hierarchical generalized linear models, we assessed potentially aggressive end-of-life care adjusting for patient demographics, tumor characteristics, and hospital referral region (HRR)-level market factors. Results: The proportion of beneficiaries receiving at least one potentially aggressive end-of-life intervention increased from 48.6% in 2006 to 50.5% in 2011 (P < .001). From 2006 to 2011, increases were apparent in repeated hospitalization (14.1% vs. 14.8%; P = .01), repeated ED visits (34.3% vs. 36.6%; P < .001), ICU admissions (16.2% vs. 21.3%; P < .001), and late hospice enrollment (11.2% vs. 12.9%; P < .001), whereas in-hospital death declined (23.5% vs. 20.9%; P < .001). End-of-life chemotherapy use (4.4% vs. 4.5%) did not change significantly over time (P = .12). The use of potentially aggressive end-of-life care varied substantially across HRRs, ranging from 40.3% to 58.3%. Few HRRs had a decrease in aggressive end-of-life care during the study period. Conclusions: Despite growing focus on providing appropriate end-of-life care, there has not been an improvement in aggressive end-of-life cancer care in the Medicare program.
AB - Objectives: To examine contemporary trends in end-of-life cancer care and geographic variation of end-of-life care aggressiveness among Medicare beneficiaries. Materials and Methods: Using the Surveillance, Epidemiology, and End Results-Medicare data, we identified 132,051 beneficiaries who died as a result of cancer in 2006-2011. Aggressiveness of end-of-life care was measured by chemotherapy received within 14 days of death, >. 1 emergency department (ED) visit within 30 days of death, >. 1 hospitalization within 30 days of death, ≥. 1 intensive care unit (ICU) admission within 30 days of death, in-hospital death, or hospice enrollment ≤. 3 days before death. Using hierarchical generalized linear models, we assessed potentially aggressive end-of-life care adjusting for patient demographics, tumor characteristics, and hospital referral region (HRR)-level market factors. Results: The proportion of beneficiaries receiving at least one potentially aggressive end-of-life intervention increased from 48.6% in 2006 to 50.5% in 2011 (P < .001). From 2006 to 2011, increases were apparent in repeated hospitalization (14.1% vs. 14.8%; P = .01), repeated ED visits (34.3% vs. 36.6%; P < .001), ICU admissions (16.2% vs. 21.3%; P < .001), and late hospice enrollment (11.2% vs. 12.9%; P < .001), whereas in-hospital death declined (23.5% vs. 20.9%; P < .001). End-of-life chemotherapy use (4.4% vs. 4.5%) did not change significantly over time (P = .12). The use of potentially aggressive end-of-life care varied substantially across HRRs, ranging from 40.3% to 58.3%. Few HRRs had a decrease in aggressive end-of-life care during the study period. Conclusions: Despite growing focus on providing appropriate end-of-life care, there has not been an improvement in aggressive end-of-life cancer care in the Medicare program.
KW - End-of-life care
KW - Geographic variation
KW - Intensity
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U2 - 10.1016/j.jgo.2015.11.007
DO - 10.1016/j.jgo.2015.11.007
M3 - Article
C2 - 26783015
AN - SCOPUS:84954304804
SN - 1879-4068
VL - 7
SP - 116
EP - 125
JO - Journal of Geriatric Oncology
JF - Journal of Geriatric Oncology
IS - 2
ER -