Karen E Bremner1,2, K Robin Yabroff3, Diarmuid Coughlan4,5, Ning Liu6, Christopher Zeruto7, Joan L Warren4, Claire de Oliveira2,6,8,9, Angela B Mariotto4, Clara Lam4, Michael J Barrett7, Kelvin K-W Chan9,10,11, Jeffrey S Hoch9,12, Murray D Krahn1,2,6,9. 1. Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada. 2. Toronto Health Economics and Technology Assessment Collaborative, Toronto, Ontario, Canada. 3. Surveillance and Health Services Research, American Cancer Society, Atlanta, GA. 4. National Cancer Institute, Rockville, MD. 5. Newcastle University, Newcastle upon Tyne, United Kingdom. 6. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 7. Information Management Services, Calverton, MD. 8. Centre for Addiction and Mental Health, Toronto, Ontario, Canada. 9. University of Toronto, Toronto, Ontario, Canada. 10. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 11. Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada and Toronto, Ontario, Canada. 12. University of California, Davis, Davis, CA.
Abstract
PURPOSE: End-of-life (EOL) cancer care is costly, with challenges regarding intensity and place of care. We described EOL care and costs for patients with colorectal cancer (CRC) in the United States and the province of Ontario, Canada, to inform better care delivery. METHODS: Patients diagnosed with CRC from 2007 to 2013, who died of any cancer from 2007 to 2013 at age ≥ 66 years, were selected from the US SEER cancer registries linked to Medicare claims (n = 16,565) and the Ontario Cancer Registry linked to administrative health data (n = 6,587). We estimated total and resource-specific costs (2015 US dollars) from public payer perspectives over the last 360 days of life by 30-day periods, by stage at diagnosis (0-II, III, IV). RESULTS: In all months, especially 30 days before death, higher percentages of SEER-Medicare than Ontario patients received chemotherapy (15.7% v 8.0%), and imaging tests (39.4% v 31.1%). A higher percentage of Ontario patients were hospitalized (62.5% v 51.0%), but 43.2% of hospitalized SEER-Medicare patients had intensive care unit (ICU) admissions versus 17.9% of hospitalized Ontario patients. Cost differences between cohorts were greater for patients with stage IV disease. In the last 30 days, mean total costs for patients with stage IV disease were $15,881 (SEER-Medicare) and $12,034 (Ontario) versus $19,354 and $17,312 for stage 0-II. Hospitalization costs were higher for SEER-Medicare patients ($11,180 v $9,434), with lower daily hospital costs in Ontario ($1,067 v $2,004). CONCLUSION: These findings suggest opportunities for reducing chemotherapy and ICU use in the United States and hospitalizations in Ontario.
PURPOSE: End-of-life (EOL) cancer care is costly, with challenges regarding intensity and place of care. We described EOL care and costs for patients with colorectal cancer (CRC) in the United States and the province of Ontario, Canada, to inform better care delivery. METHODS:Patients diagnosed with CRC from 2007 to 2013, who died of any cancer from 2007 to 2013 at age ≥ 66 years, were selected from the US SEER cancer registries linked to Medicare claims (n = 16,565) and the Ontario Cancer Registry linked to administrative health data (n = 6,587). We estimated total and resource-specific costs (2015 US dollars) from public payer perspectives over the last 360 days of life by 30-day periods, by stage at diagnosis (0-II, III, IV). RESULTS: In all months, especially 30 days before death, higher percentages of SEER-Medicare than Ontario patients received chemotherapy (15.7% v 8.0%), and imaging tests (39.4% v 31.1%). A higher percentage of Ontario patients were hospitalized (62.5% v 51.0%), but 43.2% of hospitalized SEER-Medicare patients had intensive care unit (ICU) admissions versus 17.9% of hospitalized Ontario patients. Cost differences between cohorts were greater for patients with stage IV disease. In the last 30 days, mean total costs for patients with stage IV disease were $15,881 (SEER-Medicare) and $12,034 (Ontario) versus $19,354 and $17,312 for stage 0-II. Hospitalization costs were higher for SEER-Medicare patients ($11,180 v $9,434), with lower daily hospital costs in Ontario ($1,067 v $2,004). CONCLUSION: These findings suggest opportunities for reducing chemotherapy and ICU use in the United States and hospitalizations in Ontario.
Authors: Gery P Guy; Donatus U Ekwueme; K Robin Yabroff; Emily C Dowling; Chunyu Li; Juan L Rodriguez; Janet S de Moor; Katherine S Virgo Journal: J Clin Oncol Date: 2013-09-16 Impact factor: 44.544