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End-of-life care trajectories among older adults with lung cancer

  • Author Footnotes
    1 The project was substantially completed while Dr. Davidoff was a Senior Research Scientist, Department of Health Policy and Management, Yale School of Public Health. Dr. Davidoff's current affiliation and contact information is: Health Economist & Program Director, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, United States of America.
    Amy J. Davidoff
    Correspondence
    Corresponding author at: Yale School of Public Health, New Haven, CT, United States of America.
    Footnotes
    1 The project was substantially completed while Dr. Davidoff was a Senior Research Scientist, Department of Health Policy and Management, Yale School of Public Health. Dr. Davidoff's current affiliation and contact information is: Health Economist & Program Director, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, United States of America.
    Affiliations
    Yale School of Public Health, New Haven, CT, United States of America

    Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, New Haven, CT, United States of America

    Yale Cancer Center, New Haven, CT, United States of America
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  • Maureen E. Canavan
    Affiliations
    Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, New Haven, CT, United States of America
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  • Elizabeth Prsic
    Affiliations
    Yale-Smilow Cancer Hospital, New Haven, CT, United States of America
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  • Maureen Saphire
    Affiliations
    The Ohio State University Comprehensive Cancer Center, Department of Pharmacy, Columbus, OH, United States of America
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  • Shi-Yi Wang
    Affiliations
    Yale School of Public Health, New Haven, CT, United States of America

    Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, New Haven, CT, United States of America

    Yale Cancer Center, New Haven, CT, United States of America
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  • Carolyn J. Presley
    Affiliations
    Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, New Haven, CT, United States of America

    The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Division of Medical Oncology, Columbus, OH, United States of America
    Search for articles by this author
  • Author Footnotes
    1 The project was substantially completed while Dr. Davidoff was a Senior Research Scientist, Department of Health Policy and Management, Yale School of Public Health. Dr. Davidoff's current affiliation and contact information is: Health Economist & Program Director, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, United States of America.
Published:October 03, 2022DOI:https://doi.org/10.1016/j.jgo.2022.09.010

      Abstract

      Introduction

      Medicare decedents with cancer often receive intensive care during the last month of life; however, little information exists on longer end-of-life care trajectories.

      Materials and Methods

      Using SEER-Medicare data, we selected older adults diagnosed with lung cancer between 2008 and 2013 who survived at least six months and died between 2008 and 2014. Each month we assessed claims to assign care categories ordered by intensity as follows: full-month inpatient/skilled nursing facility > cancer-directed therapy (CDT) only > concurrent CDT and symptom management and supportive care services (SMSCS) > SMSCS only > full-month hospice. We assigned each decedent to one of six trajectories: stable hospice, stable SMSCS, stable CDT with or without concurrent SMSCS, decreasing intensity, increasing intensity, and mixed. Multinomial logistic regression estimated associations between socio-demographics, calendar year, and area hospice use rates with end-of-life trajectory.

      Results

      The sample (N = 24,342) was predominantly aged ≥75 years (59.4%) and non-Hispanic White (80.5%); 19.1% lived in healthcare referral regions where ≤50% of cancer decedents received hospice care. Overall, 6.5% were continuously hospice enrolled, 25.6% received SMSCS only, and 29.4% experienced decreasing intensity; 3.9% received CDT or concurrent care, while 8.7% experienced an increase in intensity. Higher healthcare referral region hospice rates were associated with decreasing end-of-life intensity; Black, non-Hispanic decedents had a higher risk of increasing intensity and mixed patterns.

      Discussion

      Among older decedents with lung cancer, 62% had six-month end-of-life trajectories indicating low or decreasing intensity, but few received persistent CDT. Demographic characteristics, including race/ethnicity, and contextual measures, including area hospice use patterns, were associated with end-of-life trajectory.

      Keywords

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