End-of-life care in Medicare beneficiaries dying with pancreatic cancer

Kristin M. Sheffield, Casey A. Boyd, Jamie Benarroch-Gampel, Yong Fang Kuo, Catherine D. Cooksley, Taylor S. Riall

    Research output: Contribution to journalArticlepeer-review

    41 Scopus citations

    Abstract

    BACKGROUND: The authors' goal was to characterize hospice enrollment and aggressiveness of care for pancreatic cancer patients at the end of life. METHODS: Surveillance, Epidemiology, and End Results and linked Medicare claims data (1992-2006) were used to identify patients with pancreatic cancer who had died (n = 22,818). The authors evaluated hospice use, hospice enrollment ≥4 weeks before death, and aggressiveness of care as measured by receipt of chemotherapy, acute care hospitalization, and intensive care unit (ICU) admission in the last month of life. RESULTS: Overall, 56.9% of patients enrolled in hospice, and 35.9% of hospice users enrolled for 4 weeks or more. Hospice use increased from 36.2% in 1992-1994 to 67.2% in 2004-2006 (P <.0001). Admission to the ICU and receipt of chemotherapy in the last month of life increased from 15.5% to 19.6% (P <.0001) and from 8.1% to 16.4% (P <.0001), respectively. Among patients with locoregional disease, those who underwent resection were less likely to enroll in hospice before death and much less likely to enroll early. They were also more likely to receive chemotherapy (14% vs 9%, P <.0001), be admitted to an acute care hospital (61% vs 53%, P <.0001), and be admitted to an ICU (27% vs 15%, P <.0001) in the last month of life. CONCLUSIONS: Although hospice use increased over time, there was a simultaneous decrease in early enrollment and increase in aggressive care at the end of life for patients with pancreatic cancer.

    Original languageEnglish (US)
    Pages (from-to)5003-5012
    Number of pages10
    JournalCancer
    Volume117
    Issue number21
    DOIs
    StatePublished - Nov 1 2011

    Keywords

    • Medicare
    • SEER program
    • aged
    • hospice care
    • pancreatic neoplasms
    • terminal care

    ASJC Scopus subject areas

    • Oncology
    • Cancer Research

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