Abstract
To examine contemporary trends in end-of-life cancer care and geographic variation of end-of-life care aggressiveness among Medicare beneficiaries. 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. 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...Continue Reading
References
Feb 7, 1998·Medical Care·A ElixhauserR M Coffey
May 20, 2000·Annals of Internal Medicine·K E SteinhauserJ A Tulsky
Nov 18, 2000·Pharmacotherapy
Feb 15, 2003·Annals of Internal Medicine·Elliott S FisherEtoile L Pinder
Feb 15, 2003·Annals of Internal Medicine·Elliott S FisherEtoile L Pinder
Mar 15, 2003·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Craig C EarleSusan Block
May 8, 2003·JAMA : the Journal of the American Medical Association·Ellen P McCarthyRussell S Phillips
Nov 10, 2004·Health Services Research·Laurence C BakerDean Sonneborn
Dec 9, 2004·JAMA : the Journal of the American Medical Association·Peter B BachColin B Begg
Feb 17, 2005·Journal of the National Cancer Institute·Joseph Lipscomb
Feb 17, 2005·Journal of the National Cancer Institute·Nancy L KeatingEdward Guadagnoli
Jun 30, 2005·International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care·Craig C EarleJohn Z Ayanian
Dec 7, 2006·Palliative Medicine·Eva GrunfeldCraig C Earle
Aug 9, 2008·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Craig C EarleJohn Z Ayanian
Oct 9, 2008·JAMA : the Journal of the American Medical Association·Alexi A WrightHolly G Prigerson
Nov 13, 2008·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Soko SetoguchiJennifer S Haas
Mar 16, 2011·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Thi H HoCraig C Earle
May 5, 2011·Journal of the American Geriatrics Society·Joan M TenoVincent Mor
Mar 28, 2012·Journal of Pain & Palliative Care Pharmacotherapy·UNKNOWN Institute of Medicine
Apr 12, 2012·Health Affairs·Nancy E MordenDavid C Goodman
Feb 7, 2013·JAMA : the Journal of the American Medical Association·Joan M TenoVincent Mor
Jun 25, 2013·Journal of Geriatric Oncology·Amy J DavidoffMartin J Edelman
Sep 26, 2013·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Ayal A AizerPaul L Nguyen
May 2, 2014·Journal of Geriatric Oncology·Candice YongArif Hussain
Oct 8, 2014·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Alexi A WrightNancy L Keating
Nov 12, 2014·JAMA : the Journal of the American Medical Association·Joan M Teno, Pedro L Gozalo
Jul 15, 2015·Journal of Palliative Medicine·Shi-Yi WangElizabeth Bradley
Jul 23, 2015·Journal of the American Geriatrics Society·Xianglin L DuYi Cai
Jul 24, 2015·JAMA Oncology·Holly G PrigersonPaul K Maciejewski
Citations
Sep 15, 2016·Journal of Palliative Medicine·Gabriel A BrooksJoseph O Jacobson
Dec 9, 2017·The American Journal of Hospice & Palliative Care·Jennifer M Duff, Ryan M Thomas
Sep 15, 2017·Medical Care·Arif H Kamal
Jul 7, 2017·Health Affairs·Megan S SchulerLaura A Hatfield
Sep 21, 2018·Qualitative Health Research·Maria SercuPeter Pype
Nov 15, 2018·Cancer Medicine·Ryan D NippChin Hur
May 3, 2019·Journal of Oncology Practice·Claire E P SmithMichael J Kelley
Jun 13, 2019·Journal of Palliative Care·Shanthi SivendranKristina Newport
Aug 6, 2019·Cancer·Kelly M TrevinoPaul R Duberstein
Sep 8, 2019·Cancer Medicine·Timothy N HembreeAsha Ramsakal
Feb 14, 2019·Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer·AnneMarthe MjelstadAntonis Valachis
Dec 21, 2019·Cancer·Daniel E LageSarah D Berry
Mar 10, 2020·Acta Oncologica·Daniela D'AngeloMaria Grazia De Marinis
Jul 18, 2020·JCO Oncology Practice·Fauzia RiazCary P Gross
Jul 10, 2020·Asia-Pacific Journal of Oncology Nursing·Khaled OmidiParvin Mangolian Shahrbabaki
Jul 21, 2017·Journal of Oncology Practice·Cara L McDermottScott D Ramsey
Aug 8, 2020·The American Journal of Hospice & Palliative Care·Guanming ChenJiang Bian
Nov 22, 2018·Sociology of Health & Illness·Miriam WiersmaWendy Lipworth
Jul 15, 2020·International Journal of Environmental Research and Public Health·Jessica CerniHassan Hosseinzadeh
Aug 9, 2020·Blood Advances·Pamela C EganAdam J Olszewski
Feb 16, 2020·Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer·Sara L DouglasEric Blackstone
Jan 4, 2021·Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer·Amy J DavidoffCarolyn J Presley
Nov 30, 2019·Journal of Pain and Symptom Management·Maureen L SaphireAmy J Davidoff
Dec 29, 2020·Journal of the American Geriatrics Society·Risha GidwaniTodd H Wagner
Mar 23, 2021·JHEP Reports : Innovation in Hepatology·Victor de AvilaZobair M Younossi
Feb 24, 2018·Journal of Pain and Symptom Management·Ilona FridmanE Tory Higgins
Jul 11, 2020·Clinical Lung Cancer·Olivier BylickiChristos Chouaïd
Aug 25, 2021·The American Journal of Hospice & Palliative Care·Laura C PraterSeuli Bose-Brill
Aug 14, 2021·Health Services Research·Peiyin HungShi-Yi Wang
Sep 17, 2021·Japanese Journal of Clinical Oncology·Sachie ShiraneHideo Yasunaga
Sep 23, 2021·JAMA Network Open·Stephanie DeebC Jillian Tsai
Sep 29, 2021·JCO Oncology Practice·Megan A MullinsLauren P Wallner
Aug 20, 2018·Journal of Pain and Symptom Management·Cara L McDermottSean D Sullivan
Aug 11, 2018·Journal of Pain and Symptom Management·Catherine WalsheGuillermo Perez Algorta
Nov 10, 2021·JAMA : the Journal of the American Medical Association·Raymond U OsarogiagbonDeborah Schrag