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

Gulshan Sharma, Jean Freeman, Dong Zhang, James Goodwin

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

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
Pages (from-to)72-78
Number of pages7
JournalChest
Volume133
Issue number1
DOIs
StatePublished - Jan 2008

Fingerprint

Hospices
Medicare
Lung Neoplasms
Hospice Care
Fee-for-Service Plans
Terminal Care
Critical Care
Health Care Costs
Epidemiology
Databases
Neoplasms

Keywords

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

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Trends in end-of-life ICU use among older adults with advanced lung cancer. / Sharma, Gulshan; Freeman, Jean; Zhang, Dong; Goodwin, James.

In: Chest, Vol. 133, No. 1, 01.2008, p. 72-78.

Research output: Contribution to journalArticle

Sharma, Gulshan ; Freeman, Jean ; Zhang, Dong ; Goodwin, James. / Trends in end-of-life ICU use among older adults with advanced lung cancer. In: Chest. 2008 ; Vol. 133, No. 1. pp. 72-78.
@article{15afa9d42939444492bbef9d6380cb57,
title = "Trends in end-of-life ICU use among older adults with advanced lung cancer",
abstract = "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.",
keywords = "End-of-life care, Hospice use, Icu care, Lung cancer, Older adults, Utilization",
author = "Gulshan Sharma and Jean Freeman and Dong Zhang and James Goodwin",
year = "2008",
month = "1",
doi = "10.1378/chest.07-1007",
language = "English",
volume = "133",
pages = "72--78",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "1",

}

TY - JOUR

T1 - Trends in end-of-life ICU use among older adults with advanced lung cancer

AU - Sharma, Gulshan

AU - Freeman, Jean

AU - Zhang, Dong

AU - Goodwin, James

PY - 2008/1

Y1 - 2008/1

N2 - 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.

AB - 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.

KW - End-of-life care

KW - Hospice use

KW - Icu care

KW - Lung cancer

KW - Older adults

KW - Utilization

UR - http://www.scopus.com/inward/record.url?scp=38349049354&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=38349049354&partnerID=8YFLogxK

U2 - 10.1378/chest.07-1007

DO - 10.1378/chest.07-1007

M3 - Article

VL - 133

SP - 72

EP - 78

JO - Chest

JF - Chest

SN - 0012-3692

IS - 1

ER -