Dying well: How equal is end of life care among gynecologic oncology patients?

Taylor, Jolyn; Brown, Alaina J.; Prescott, Lauren S.; Sun, Charlotte C.; Ramondetta, Lois M.; Bodurka, Diane C.

doi:10.1016/j.ygyno.2015.12.012

Cited by 28 publications

(27 citation statements)

References 16 publications

(21 reference statements)

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“…19 We observed that 6.6% of patients received chemotherapy during the last 14 days of life, which is similar to 4% reported in a single institution retrospective review of gynecologic oncology patients and 4.8 – 12.7% in a multi country retrospective study of patients with multiple tumor types during the last 30 days of life. 1,20 Our data from a large cohort of elderly women with uterine cancer revealed similar trends; the use of hospital services and chemotherapy are common at the end of life.…”

Section: Discussionmentioning

confidence: 75%

“…Up to 24% of patients with a gynecologic malignancy including ovarian, uterine, cervical vaginal or vulvar cancer have been reported to receive “aggressive medical care” in the last 30 days of life including chemotherapy, hospital admission and intensive care unit admission. 7 Patients who experience more intensive medical care at the end of life are more likely to report poorer quality of life. 8 …”

Section: Introductionmentioning

confidence: 99%

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Trends in end-of-life care and health care spending in women with uterine cancer

Margolis

Chen

Accordino

et al. 2017

American Journal of Obstetrics and Gynecology

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Background High intensity care including hospitalizations, chemotherapy and other interventions at the end of life is costly and often of little value for cancer patients. Little is known about patterns of end of life care and resource utilization for women with uterine cancer. Objective We examined the costs and predictors of aggressive end of life care for women with uterine cancer. Methods In this observational cohort study the Surveillance, Epidemiology and End Results-Medicare linked database was used to identify women ≥65 who died from uterine cancer from 2000–2011. Resource utilization in the last month of life including ≥2 hospital admissions, >1 emergency department visit, ≥1 intensive care unit admission or use of chemotherapy in the last 14 days of life was examined. High intensity care was defined as the occurrence of any of the above outcomes. Logistic regression models were developed to identify factors associated with high intensity care. Total Medicare expenditures in the last month of life are reported. Results Of the 5,873 patients identified, the majority had stage IV (30.2%) cancer, were white (79.9%) and had endometrioid tumors (47.6%). High intensity care was rendered to 42.5% of women. During the last month of life, 15.0% had ≥2 hospital admissions, 9.0% had a hospitalization >14 days, 15.3% had >1 emergency department visits, 18.3% had an intensive care unit admission and 6.6% received chemotherapy in the last 14 days of life. The percentage of women who received high intensity care was stable over the study period. Characteristics of younger age, black race, higher number of comorbidities, stage IV disease, residence in the eastern US and more recent diagnosis were associated with high intensity care. The median Medicare payment during the last month of life was $7,645. Total per beneficiary Medicare payments remained stable from $9,656 (IQR, $3,190–$15,890) in 2000 to $9,208 (IQR, $3,309–$18,554) by 2011. The median healthcare expenditure was four times as high for those who received high intensity care compared to those who did not (median $16,173 vs $4,099). Conclusion Among women with uterine cancer, high intensity care is common in the last month of life, associated with substantial monetary expenditures, and does not appear to be decreasing.

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Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Trends in end-of-life care and health care spending in women with uterine cancer

Margolis

Chen

Accordino

et al. 2017

American Journal of Obstetrics and Gynecology

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“…Acceptance of hospice care is increasing on a national level, including among patients with ovarian cancer, the deadliest gynecologic malignancy [9][10][11][12]. However, disparities still exist among ovarian cancer patients with regard to hospice usage and receiving invasive end of life care [11][12][13][14]. Ovarian cancer patients of minority race and ethnicity and those of lower socioeconomic status have less hospice use and more aggressive end of life care, similar to patterns seen in other disease sites [15,16].…”

Section: Introductionmentioning

confidence: 99%

How we use hospice: Hospice enrollment patterns and costs in elderly ovarian cancer patients

Taylor

Zhang

Rajan³

et al. 2019

Gynecologic Oncology

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To describe disparities in patterns of hospice use and end-of-life costs among ovarian cancer patients. Methods. Using Texas Cancer Registry-Medicare data, ovarian cancer patients deceased 2005-2012 with N12 months of continuous Medicare coverage before death were included. Descriptive statistics and multivariable logistic regressions were used to evaluate patterns of hospice use. Cost and resource utilization was obtained from Medicare claims and analyzed using a non-parametric Mann-Whitney test. Results. 2331 patients were assessed: 1788 (77%) white, 359 (15%) Hispanic, 158 (7%) black and 26 (1%) other. 1756 (75%) enrolled in hospice prior to death but only 1580 (68%) died with hospice. 176 (10%) of 1756 patients unenrolled and died without hospice. 346 (20%) unenrolled from hospice multiple times. From 2008 to 2012, patients were less likely to unenroll from hospice prior to death. Black patients were more likely to unenroll from hospice prior to death (OR 2.07 [1.15-3.73]; p = 0.02) compared to white patients. The median amount paid by Medicare during the last six months of life was $38,530 for those in hospice compared to $49,942 if never enrolled in hospice (p b 0.0001) and was higher for black and Hispanic patients compared to white patients. 30% hospice unenrolled patients and 40% multiply enrolled hospice patients received at least one life extending or invasive care procedure following unenrollment from hospice. Conclusion. Recently, more patients remain enrolled in hospice, but black patients have a higher risk of unenrollment. Hospice enrollment was associated with lower costs as long as a patient did not unenroll from hospice.

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“…This notable finding corroborates a single earlier study investigating the impact of race on timing of advance directives or EOL discussions in pediatric cancer patients, 41 yet deviates substantially from the adult oncology literature in which race impacts access to and utilization of PC resources and services. 42 The issue of race as it relates to early integration of PC warrants extensive further exploration in the context of pediatric oncology.…”

Section: Discussionmentioning

confidence: 99%