Association of age, gender, and race with intensity of end-of-life care for Medicare beneficiaries with cancer.

Document Type

Article

Publication Date

5-1-2012

Institution/Department

Maine Medical Center Research Institute, Center for Outcomes Research and Evalution

Journal Title

Journal of palliative medicine

MeSH Headings

Age Factors, Aged, Continental Population Groups, Female, Humans, Logistic Models, Male, Medicare Part A, Medicare Part B, Neoplasms, Retrospective Studies, Sex Factors, Terminal Care, United States

Abstract

PURPOSE: To measure intensity of end-of-life (EOL) care for Medicare cancer patients and variations in care by age, gender, and race.

PATIENTS AND METHODS: This retrospective cohort analysis of Medicare claims (20% sample) examined 235,821 Medicare Parts A and B fee-for-service patients dying with poor-prognosis cancers between 2003 and 2007. Logistic regression models quantified associations between care intensity and age, gender, and race. Measures included hospitalizations, emergency department (ED) visits, intensive care unit (ICU) admissions, in-hospital deaths, late-life chemotherapy administration, overall and late hospice enrollment within six months of death.

RESULTS: Within 30 days of death, 61.3% of patients were hospitalized, 10.2% were hospitalized more than once, 10.2% visited an ED more than once, 23.7% had ICU admissions, and 28.8% died in-hospital. Within two weeks of death, 6% received chemotherapy. In their final six months, 55.2% accessed hospice, 15.1% within three days of death. Older age (≥75 versus

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

ISSN

1557-7740

First Page

548

Last Page

554

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