Melissa K Accordino1,2, Jason D Wright3,4, Sowmya Vasan5, Alfred I Neugut6,3,5, Tal Gross7, Grace C Hillyer3,5, Dawn L Hershman6,3,5. 1. Department of Medicine, Columbia University College of Physicians and Surgeons, 161 Ft Washington Ave, Room 9-962, New York, NY, 10032, USA. Mkg2134@cumc.columbia.edu. 2. Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA. Mkg2134@cumc.columbia.edu. 3. Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA. 4. Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA. 5. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. 6. Department of Medicine, Columbia University College of Physicians and Surgeons, 161 Ft Washington Ave, Room 9-962, New York, NY, 10032, USA. 7. Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, USA.
Abstract
PURPOSE: For women with stage IV breast cancer (BC), the association between survival time (ST) and use of aggressive end-of-life (EOL) care is unknown. METHODS: We used the SEER-Medicare database to identify women with stage IV BC diagnosed 2002-2011 who died by 12/31/2012. Aggressive EOL care was defined as receipt in the last month of life: >1 ED visit, >1 hospitalization, ICU admission, life-extending procedures, hospice admission within 3 days of death, IV chemotherapy within 14 days of death, and/or ≥10 unique physician encounters in the last 6 months of life. Receipt of aggressive EOL care and hospice in the last month of life were determined using claims, and multivariable analysis was used to identify factors associated with receipt. Costs of care were also evaluated. RESULTS: We identified 4521 eligible patients. Of these, 2748 (60.8%) received aggressive EOL care. Factors associated with aggressive EOL care were race (OR 1.45, 95% CI 1.19-1.81 for blacks compared to whites) and more frequent oncology office visits (OR 1.56, 95% CI 1.28-1.90). Patients who lived >12 months after diagnosis were less likely to receive aggressive EOL care (OR 0.44, 95% CI 0.38-0.52), and more likely to utilize hospice (OR 1.43, 95% CI 1.21-1.69) compared to patients who lived ≤6 months. Patients with a shorter ST had significantly higher costs of care per-month-alive compared to patients with longer ST. CONCLUSION: Patients with a shorter ST were more likely to receive aggressive EOL care and had higher costs of care compared to patients who lived longer.
PURPOSE: For women with stage IV breast cancer (BC), the association between survival time (ST) and use of aggressive end-of-life (EOL) care is unknown. METHODS: We used the SEER-Medicare database to identify women with stage IV BC diagnosed 2002-2011 who died by 12/31/2012. Aggressive EOL care was defined as receipt in the last month of life: >1 ED visit, >1 hospitalization, ICU admission, life-extending procedures, hospice admission within 3 days of death, IV chemotherapy within 14 days of death, and/or ≥10 unique physician encounters in the last 6 months of life. Receipt of aggressive EOL care and hospice in the last month of life were determined using claims, and multivariable analysis was used to identify factors associated with receipt. Costs of care were also evaluated. RESULTS: We identified 4521 eligible patients. Of these, 2748 (60.8%) received aggressive EOL care. Factors associated with aggressive EOL care were race (OR 1.45, 95% CI 1.19-1.81 for blacks compared to whites) and more frequent oncology office visits (OR 1.56, 95% CI 1.28-1.90). Patients who lived >12 months after diagnosis were less likely to receive aggressive EOL care (OR 0.44, 95% CI 0.38-0.52), and more likely to utilize hospice (OR 1.43, 95% CI 1.21-1.69) compared to patients who lived ≤6 months. Patients with a shorter ST had significantly higher costs of care per-month-alive compared to patients with longer ST. CONCLUSION:Patients with a shorter ST were more likely to receive aggressive EOL care and had higher costs of care compared to patients who lived longer.
Entities:
Keywords:
Breast cancer; End-of-life care; Health services overuse; Healthcare quality; Hospice
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