Submission Type

Original Research


Background: Many cancer patients receive overly-intensive care at end-of-life (EOL), despite recognition that this is a marker of poor quality. There is limited knowledge about care received by patients dying with melanoma.

Objective: We characterized healthcare utilization during EOL and patient characteristics associated with variations in care. We also described how utilization changed over time.

Methods: We used the Surveillance, Epidemiology, and End Results-Medicare database to identify 9099 melanoma patients aged 65+ at diagnosis between 2000 and 2009, who died by 12/31/2010. We included patients enrolled in Medicare part A and B six-months prior to diagnosis and not in managed care for the last 30 days of life. We examined utilization patterns during the last month of life.

Results: Among 9099 patients dying with melanoma, 5% had ≥ two ED visits, 3% had ≥ two hospitalizations and 5% had an ICU stay during their last month of life; 7.5% died in the hospital and 2% received chemotherapy during their last two weeks of life. Multivariable analysis revealed that married patients, males or those with higher comorbidity burden received higher intensity EOL care. Temporal analysis revealed a doubling in the number of patients with multiple hospitalizations (4% in 2010 vs 2% in 2001), ED visits (6% in 2010 vs 3% in 2001) and ICU care (7% in 2010 vs 3% in 2001).

Conclusion: Patients with melanoma in the US are receiving EOL care that meets or exceeds benchmarks; however, temporal analysis revealed increasing healthcare utilization during EOL over the study period.



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