Trends in end-of-life ICU use among older adults with advanced lung cancer

Gulshan Sharma, Jean Freeman, Dong Zhang, James S. Goodwin

Research output: Contribution to journalArticlepeer-review

93 Scopus citations


Background: There is increasing concern about the appropriateness of intensive medical care near the end of life in ICUs throughout the United States. As a result of hospice expansion in the 1990s, we hypothesized that ICU use decreased over time in older adults with advanced lung cancer. Methods: Retrospective analysis using the linked Surveillance, Epidemiology and End Results Medicare database. There were 45,627 Medicare beneficiaries ≥ 66 years of age with confirmed stage IIIB or IV lung cancer between January 1, 1992, and December 31, 2002, who died within a year of their cancer diagnosis from 1993 through 2002. Results: ICU use in the last 6 months of life increased from 17.5% in 1993 to 24.7% in 2002 (p < 0.001). After adjusting for patient characteristics, there was a 6.6% annual increase in ICU use from 1993 to 2002. During the same period, hospice use had risen from 28.8 to 49.9% (p < 0.001). A total of 6.2% of patients received both end-of-life ICU care and hospice care, a percentage that increased over time. The total health-care cost for Medicare fee-for-service patients during last 6 months was $40,929 for ICU users and $27,160 for non-ICU users (p < 0.001). Conclusion: Despite increasing hospice use, ICU utilization among older adults dying with advanced lung cancer continued to rise in the United States during the 1990s.

Original languageEnglish (US)
Pages (from-to)72-78
Number of pages7
Issue number1
StatePublished - Jan 2008


  • End-of-life care
  • Hospice use
  • Icu care
  • Lung cancer
  • Older adults
  • Utilization

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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