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

Abstract

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.

Trends and racial disparities in aggressive end‐of‐life care for a national sample of women with ovarian cancer

“…We also observed similar results when conducting sensitivity analysis in which the cohort was defined by cancer cause of death. Similar to the patterns observed in other cancers, these results suggest that the use of aggressive end‐of‐life care persists among women with ovarian cancer 22‐25 . Our findings build on these prior studies by including nearly a decade of new data reflecting end‐of‐life care at a time when there was increased emphasis on improving the quality of this care and expanding it to a national scope.…”

Costs of cancer along the care continuum: What we can expect based on recent literature

“…In 1 study of uterine cancer, median costs were >$9000 in the last month of life. 29 Among men, costs ranged from approximately $43,000 (2008 US dollars) 28 for prostate cancer to $133,183 for leukemia (2010 US dollars) 18 ( Table 1). Survivors with stage IV disease had costs approximately 2 times as high as those with stage I disease.…”

High-Intensity End-of-Life Care Among Patients With GI Cancer in Puerto Rico: A Population-Based Study

“…We also found a higher proportion of patients using high-intensity care in terms of chemotherapy, hospitalizations, and ER visits than other studies. 11 , 12 , 19 , 25 , 39 , 40 …”