Association of Age, Gender, and Race with Intensity of End-of-Life Care for Medicare Beneficiaries with Cancer

Miesfeldt, Susan; Murray, Kimberly; Lucas, Lee; Chang, Chiang‐Hua; Goodman, David C.; Morden, Nancy E.

doi:10.1089/jpm.2011.0310

Cited by 124 publications

(143 citation statements)

References 36 publications

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“…For instance, women had lower odds of hospitalization and receipt of aggressive care in several EOL care studies, whereas individuals who reported a black race/ethnicity, a lower SES, and comorbidities had higher odds. [28][29][30][31][32] Our finding that increased age was associated with lower rehospitalization rates was consistent with results of a Canadian study on EOL care for advanced pancreatic cancer 33 and a US study of Medicare beneficiaries with poor-prognosis cancers in the last 6 months of life. 28 However, this finding was inconsistent with one study, in which increased age was associated with more aggressive EOL care.…”

Section: Discussionsupporting

confidence: 82%

“…[28][29][30][31][32] Our finding that increased age was associated with lower rehospitalization rates was consistent with results of a Canadian study on EOL care for advanced pancreatic cancer 33 and a US study of Medicare beneficiaries with poor-prognosis cancers in the last 6 months of life. 28 However, this finding was inconsistent with one study, in which increased age was associated with more aggressive EOL care. 31 Our multistate modeling approach fully accounted for time during which individuals were not at risk for hospitalization (because of either death or time spent in the hospital).…”

Section: Discussionsupporting

confidence: 82%

“…Inpatient care drives regional variation in costs for advanced cancer care, which suggests that health system factors or local practice patterns, rather than clinical need alone, may drive care provision to some extent. 10 In addition, planned hospitalizations for individuals with advanced cancer may be considered potentially avoidable in cases for which improved communication about prognosis, advanced care planning, and Covariates included the following: age, sex, race/ethnicity, insurance status, marital status, area-based socioeconomic status quintile (SES), 28 and comorbidities (Table 1). Hospital characteristics, derived from the 2012 OSHPD Hospital Annual Utilization Report, included the following: hospital size, ownership type, presence of a teaching program, and presence of an outpatient palliative care program (described in the Appendix, online only).…”

Section: Outcomes and Variable Definitionsmentioning

confidence: 99%

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Hospitalization Rates and Predictors of Rehospitalization Among Individuals With Advanced Cancer in the Year After Diagnosis

Whitney

Bell

Tancredi

et al. 2017

JCO

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Among individuals with advanced cancer, frequent hospitalization increasingly is viewed as a hallmark of poor-quality care. We examined hospitalization rates and individual-and hospital-level predictors of rehospitalization among individuals with advanced cancer in the year after diagnosis. MethodsIndividuals diagnosed with advanced breast, colorectal, non-small-cell lung, or pancreatic cancer from 2009 to 2012 (N = 25,032) were identified with data from the California Cancer Registry (CCR).After linkage with inpatient discharge data, multistate and log-linear Poisson regression models were used to calculate hospitalization rates and to model rehospitalization in the year after diagnosis, accounting for survival. ResultsIn the year after diagnosis, 71% of individuals with advanced cancer were hospitalized, 16% had three or more hospitalizations, and 64% of hospitalizations originated in the emergency department. Rehospitalization rates were significantly associated with black non-Hispanic (incidence rate ratio [IRR], 1.29; 95% CI, 1.17 to 1.42) and Hispanic (IRR, 1.11; 95% CI, 1.03 to 1.20) race/ ethnicity; public insurance (IRR, 1.37; 95% CI, 1.23 to 1.47) and no insurance (IRR, 1.17; 95% CI, 1.02 to 1.35); lower socioeconomic status quintiles (IRRs, 1.09 to 1.29); comorbidities (IRRs, 1.13 to 1.59); and pancreatic (IRR, 2.07; 95% CI, 1.95 to 2.20) and non-small-cell lung (IRR, 1.69; 95% CI, 1.54 to 1.86) cancers versus colorectal cancer. Rehospitalization rates were significantly lower after discharge from a hospital that had an outpatient palliative care program (IRR, 0.90; 95% CI, 0.83 to 0.97) and were higher after discharge from a for-profit hospital (IRR, 1.33; 95% CI, 1.14 to 1.56). ConclusionIndividuals with advanced cancer experience a heavy burden of hospitalization in the year after diagnosis. Efforts to reduce hospitalization and provide care congruent with patient preferences might target individuals at higher risk. Future work might explore access to palliative care in the community and related health care use among individuals with advanced cancer.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 82%

Section: Outcomes and Variable Definitionsmentioning

confidence: 99%

See 1 more Smart Citation

Hospitalization Rates and Predictors of Rehospitalization Among Individuals With Advanced Cancer in the Year After Diagnosis

Whitney

Bell

Tancredi

et al. 2017

JCO

View full text Add to dashboard Cite

show abstract

“…8,9 However, rates have been slowly rising over the last decade, and 5% to 22% of all patients with advanced cancer receive chemotherapy within 2 weeks of death. [2][3][4][10][11][12][13][14][15][16][17][18] Previous research on chemotherapy administration at EOL has primarily focused on predictors and outcomes. Although these studies have helped to identify the scope of the problem, few have examined when and how oncologists discontinue chemotherapy, including how the timing influences patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Processes of Discontinuing Chemotherapy for Metastatic Non–Small-Cell Lung Cancer at the End of Life

Pirl

Greer

Irwin

et al. 2015

JOP

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Purpose: Administration of chemotherapy close to death is widely recognized as poor-quality care. Prior research has focused on predictors and outcomes of chemotherapy administration at the end of life. This study describes processes of chemotherapy discontinuation and examines their relationships with timing before death, hospice referral, and hospital death. Patients and Methods:We reviewed health records of a prospective cohort of 151 patients with newly diagnosed metastatic nonsmall-cell lung cancer who participated in a trial of early palliative care. Chemotherapy treatments during final regimen were qualitatively analyzed to identify categories of discontinuation processes. We then quantitatively compared predictors and outcomes of the process categories.

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“…16 In comparison, in the final 6 months of their life, 55% of patients with cancer enrolled in hospice, and only 15% enroll within 3 days of their death. 17 We hypothesize that palliative care has the potential to improve clinical outcomes for patients living with HF by improving pain and other symptom control, clarifying goals of care, and guiding treatment decisions to meet those goals.…”

Section: Introductionmentioning

confidence: 99%

Engaging Heart Failure Clinicians To Increase Palliative Care Referrals: Overcoming Barriers, Improving Techniques

Gelfman

Kalman²,

Goldstein³

2014

Journal of Palliative Medicine

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Background: Heart failure (HF) is the most common cause of hospitalization among adults over the age of 65. Hospital readmission rates, mortality rates, and Medicare costs for patients with this disease are high. Furthermore, patients with HF experience a number of symptoms that worsen as the disease progresses. However, a small minority of patients with HF receives hospice or palliative care. One possible reason for this may be that the HF and palliative care clinicians have differing perspectives on the role of palliative care for these patients. Aim: The goal of the article is to offer palliative care clinicians a roadmap for collaborating with HF clinicians by reviewing the needs of patients with HF. Conclusions: This article reviews the needs of patients with HF and their families, the barriers to referral to palliative care for patients with HF, and provides suggestions for improving collaboration between palliative care and HF clinicians.

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Association of Age, Gender, and Race with Intensity of End-of-Life Care for Medicare Beneficiaries with Cancer

Abstract: Seniors dying with poor-prognosis cancer experience high-intensity care with rates varying by age, gender, and race.

Cited by 124 publications

References 36 publications

Hospitalization Rates and Predictors of Rehospitalization Among Individuals With Advanced Cancer in the Year After Diagnosis

Hospitalization Rates and Predictors of Rehospitalization Among Individuals With Advanced Cancer in the Year After Diagnosis

Processes of Discontinuing Chemotherapy for Metastatic Non–Small-Cell Lung Cancer at the End of Life

Engaging Heart Failure Clinicians To Increase Palliative Care Referrals: Overcoming Barriers, Improving Techniques

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