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 journalArticle

27 Citations (Scopus)

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

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Hospices
Terminal Care
Medicare
Pancreatic Neoplasms
Intensive Care Units
Drug Therapy
Epidemiology
Hospitalization

Keywords

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

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Sheffield, K. M., Boyd, C. A., Benarroch-Gampel, J., Kuo, Y. F., Cooksley, C. D., & Riall, T. S. (2011). End-of-life care in Medicare beneficiaries dying with pancreatic cancer. Cancer, 117(21), 5003-5012. https://doi.org/10.1002/cncr.26115

End-of-life care in Medicare beneficiaries dying with pancreatic cancer. / Sheffield, Kristin M.; Boyd, Casey A.; Benarroch-Gampel, Jamie; Kuo, Yong Fang; Cooksley, Catherine D.; Riall, Taylor S.

In: Cancer, Vol. 117, No. 21, 01.11.2011, p. 5003-5012.

Research output: Contribution to journalArticle

Sheffield, KM, Boyd, CA, Benarroch-Gampel, J, Kuo, YF, Cooksley, CD & Riall, TS 2011, 'End-of-life care in Medicare beneficiaries dying with pancreatic cancer', Cancer, vol. 117, no. 21, pp. 5003-5012. https://doi.org/10.1002/cncr.26115
Sheffield KM, Boyd CA, Benarroch-Gampel J, Kuo YF, Cooksley CD, Riall TS. End-of-life care in Medicare beneficiaries dying with pancreatic cancer. Cancer. 2011 Nov 1;117(21):5003-5012. https://doi.org/10.1002/cncr.26115
Sheffield, Kristin M. ; Boyd, Casey A. ; Benarroch-Gampel, Jamie ; Kuo, Yong Fang ; Cooksley, Catherine D. ; Riall, Taylor S. / End-of-life care in Medicare beneficiaries dying with pancreatic cancer. In: Cancer. 2011 ; Vol. 117, No. 21. pp. 5003-5012.
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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.",
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N2 - 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.

AB - 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.

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