The Impact of Hospice Services in the Care of Patients with Advanced Stage Nonsmall Cell Lung Cancer

DugganKristy, T; Duffus, Sara H.; B.Jr., D'AgostinoRalph; PettyWilliam, J; StreerNathan, P; StephensonRichard, C

doi:10.1089/jpm.2016.0064

Cited by 20 publications

(17 citation statements)

References 17 publications

(18 reference statements)

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“…Thus, our study provides evidence that hospice substitutes for more expensive procedures often utilized at end of life. Our results are consistent with a prior study that found a lower likelihood of starting a new chemotherapy agent in the last 30 days of life among patients with lung cancer who used hospice, 15 but to our knowledge, ours is the first study to also demonstrate a reduction in radiation therapy sessions among hospice users. An important finding from our subgroup analysis is the role of length of hospice enrollment on cost savings.…”

Section: Discussionsupporting

confidence: 92%

“…Some studies have found lower hospitalizations 9,15 and emergency department (ED) 9,15 and intensive care unit 9,15 visits as likely contributors to cost savings. However, chemotherapy 15 and radiation therapy sessions, which contribute significantly toward end-of-life costs among patients with cancer, have been often overlooked. In fact, chemotherapy and radiation therapy sessions make larger contributions to end-of-life outpatient service costs among patients with cancer than ED visits.…”

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confidence: 99%

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Impact of Hospice on Spending and Utilization Among Patients With Lung Cancer in Medicare

Kalidindi

Segel

Jung

2019

Am J Hosp Palliat Care

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Objectives: To compare patterns and understand drivers of spending and utilization by month in the last 6 months of life between patients with lung cancer who used hospice versus those who did not. Study Design: Retrospective cohort analysis using 2009 to 2013 Medicare claims. Methods: We used a 10% random sample of Medicare fee-for-service beneficiaries with lung cancer who died between 2010 and 2013 (43 789 beneficiaries). Patients were assigned to 2 groups depending on whether they used hospice care in the last 6 months of life. The following outcomes were constructed by month: (1) all-cause Medicare spending, (2) indicator of hospitalization, (3) indicator of emergency department (ED) visit, (4) number of part B chemotherapy claims, and (5) number of radiation therapy sessions. We used a combination of propensity score matching and regression analysis to compare outcomes between the 2 groups. Results: Patients who used hospice had significantly lower spending in the last month of life compared to nonusers (US$16 907 vs US$26 906, P < .00). The spending differences in the last month of life between the 2 groups were largely driven by lower likelihood of hospitalization (54% vs 80%, P < .01) and ED visits (15% vs 22%, P < .01) and fewer chemotherapy (0.12 vs 0.32, P < .01) and radiation therapy sessions (0.80 vs 1.26, P < .01). During the other months in the 6-month period, spending was similar between the 2 groups. Conclusions: Timely hospice enrollment of patients with lung cancer—the group suffering from high morbidity and mortality among patients with cancer—may lead to significant cost savings.

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Section: Discussionsupporting

confidence: 92%

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confidence: 99%

Impact of Hospice on Spending and Utilization Among Patients With Lung Cancer in Medicare

Kalidindi

Segel

Jung

2019

Am J Hosp Palliat Care

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“…Residents in Census tracts with a high percentage of minorities also were less likely to receive hospice care, 82 which could have implications for cancer survival. 83 These reported disparities in care are consistent with our finding that black ethnic density is associated with greater mortality.…”

Section: Ethnic Density and Cancer/fang And Tsengsupporting

confidence: 88%

Ethnic density and cancer: A review of the evidence

Fang

Tseng

2018

Cancer

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Accumulating data suggest that factors in the social environment may be associated with cancer-related outcomes. Ethnic density, defined as the proportion of racial/ethnic minority individuals residing in a given geographic area, is 1 of the most frequently studied social environment factors, but studies on ethnic density and cancer have yielded inconsistent findings. Thus, the objective of the current review was to summarize the extant data on ethnic density and cancer-related outcomes (cancer risk, stage at diagnosis, and mortality) with the aim of identifying pathways by which ethnic density may contribute to outcomes across populations. In general, the findings indicated an association between ethnic density and increased risk for cancers of infectious origin (eg, liver, cervical) but lower risk for breast and colorectal cancers, particularly among Hispanic and Asian Americans. Hispanic ethnic density was associated with greater odds of late-stage cancer diagnosis, whereas black ethnic density was associated with greater mortality. In addition, this review highlights several methodological and conceptual issues surrounding the measurement of ethnic neighborhoods and their available resources. Clarifying the role of neighborhood ethnic density is critical to developing a greater understanding of the health risks and benefits accompanying these environments and how they may affect racial and ethnic disparities in cancer-related outcomes. Cancer 2018;124:1877-903. © 2018 American Cancer Society.

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“…The 6-month, 1-year, and 2-year overall survival rates of the 102 patients with metastatic NSCLC were 17.65%, 3.92%, and 0.98%, respectively. The median overall survival of the 102 patients was 3.15 months ( Figure 2), which was consistent with that in previous studies, which reported a median overall survival of 3-5 months (24)(25)(26). These results provide greatly important basic survival data to researchers evaluating new treatment strategies for patients with recurrent stage III/IV NSCLC who show progression on multiple conventional treatments.…”

Section: Overall Survival Analysis Of All Patients With Advanced Stagsupporting

confidence: 89%

Association of tumor mutation burden and epidermal growth factor receptor inhibitor history with survival in patients with metastatic stage III/IV non-small-cell lung cancer: A retrospective study

Lan¹,

Zhou²,

Feng³

et al. 2021

Clinics

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Lung cancer is the leading cause of cancer-related deaths worldwide. However, factors associated with the survival of patients with advanced non-small-cell lung cancer (NSCLC) who received only hospice care are largely unclear. In this study, we aimed to determine the prognostic factors correlated with survival in patients with advanced NSCLC who had undergone hospice care only. METHODS: A total of 102 patients with recurrent stage III/IV NSCLC after traditional treatment failure were investigated. Survival was measured from the date of enrollment to December 2019 or the time of death. Tumor tissues were collected, and DNA sequencing was performed to identify somatic mutations. Data on clinical factors of patients were collected and analyzed by univariate and multivariate analyses. Overall survival analysis was conducted using the Kaplan-Meier method. RESULTS: The 6-month, 1-year, and 2-year overall survival rates of the 102 patients with metastatic NSCLC were 17.65%, 3.92%, and 0.98%, respectively. The median overall survival of the 102 patients was 3.15 months. Tumor location in the peripheral lung, epidermal growth factor receptor (EGFR) inhibitor history, low tumor mutation load, adenocarcinoma, and poor performance status score were associated with prolonged survival compared with tumor location in the central lung, no EGFR inhibitor history, high tumor mutation load, squamous cell carcinoma, and good performance status score (p=0.045, p=0.003, p=0.045, p=0.021, and p=0.0003, respectively). CONCLUSIONS: EGFR inhibitor treatment history and tumor mutation load are risk factors for the overall survival of patients with stage III/IV NSCLC who have undergone only hospice care. These results provide a critical clinical basis for further study of nontraditional anti-tumor responses induced by EGFR inhibitors.

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The Impact of Hospice Services in the Care of Patients with Advanced Stage Nonsmall Cell Lung Cancer

Abstract: This study demonstrates that, among patients with metastatic NSCLC, hospice enrollment was associated with optimized EOL oncological care and a significantly longer median survival.

Cited by 20 publications

References 17 publications

Impact of Hospice on Spending and Utilization Among Patients With Lung Cancer in Medicare

Impact of Hospice on Spending and Utilization Among Patients With Lung Cancer in Medicare

Ethnic density and cancer: A review of the evidence

Association of tumor mutation burden and epidermal growth factor receptor inhibitor history with survival in patients with metastatic stage III/IV non-small-cell lung cancer: A retrospective study

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