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Chemotherapy Use in the Months Before Death and Estimated Costs of Care in the Last Week of Life.

ABSTRACT: CONTEXT:Considerable attention has been paid to the disproportionately high costs of care for patients nearing death, yet little is known about the costs associated with chemotherapy use among end-stage cancer patients. OBJECTIVES:To compare costs of care other than chemotherapy in the last week of life based on whether cancer patients were using chemotherapy in the months just before death. METHODS:A total of 311 patients with advanced cancer who died between 2002 and 2008 were studied. Data included medical records, patient baseline surveys (median four months before death), and postmortem interviews of caregivers and clinicians. Costs of care were estimated based on reports of death site and services other than chemotherapy received in the week before death (e.g., resuscitation). We tested whether end-of-life (EOL) care preferences, do-not-resuscitate order completion, or EOL discussions accounted for relationships between chemotherapy use and estimated care costs. RESULTS:Half (50.5%) of patients were receiving chemotherapy at baseline. Estimated EOL care costs for patients with baseline chemotherapy use (median = $2681) were significantly higher than for patients without baseline chemotherapy use (median = $1092) (P = 0.003). This relationship persisted after adjusting for sociodemographic and clinical characteristics in a generalized linear model (mean incremental cost = $2681, 95% confidence interval $611-$4751, P = 0.01). None of the psychosocial variables accounted for the relationship between chemotherapy use and estimated care costs. CONCLUSION:Chemotherapy for end-stage cancer patients is associated with higher estimated EOL care costs. Given evidence of limited benefit and potential harm of chemotherapy for end-stage cancer patients, the cost-effectiveness of such care is questioned and further study warranted.

SUBMITTER: Garrido MM

PROVIDER: S-EPMC4875864 | biostudies-literature | 2016 May

REPOSITORIES: biostudies-literature

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Chemotherapy Use in the Months Before Death and Estimated Costs of Care in the Last Week of Life.

Garrido Melissa M MM Prigerson Holly G HG Bao Yuhua Y Maciejewski Paul K PK

Journal of pain and symptom management 20160217 5

<h4>Context</h4>Considerable attention has been paid to the disproportionately high costs of care for patients nearing death, yet little is known about the costs associated with chemotherapy use among end-stage cancer patients.<h4>Objectives</h4>To compare costs of care other than chemotherapy in the last week of life based on whether cancer patients were using chemotherapy in the months just before death.<h4>Methods</h4>A total of 311 patients with advanced cancer who died between 2002 and 2008 ...[more]

PMID: 26899821

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Project description:Common diseases, particularly dementia, have large social costs for the U.S. population. However, less is known about the end-of-life costs of specific diseases and the associated financial risk for individual households.To examine social costs and financial risks faced by Medicare beneficiaries 5 years before death.Retrospective cohort.The HRS (Health and Retirement Study).Medicare fee-for-service beneficiaries, aged 70 years or older, who died between 2005 and 2010 (n = 1702), stratified into 4 groups: persons with a high probability of dementia or those who died because of heart disease, cancer, or other causes.Total social costs and their components, including Medicare, Medicaid, private insurance, out-of-pocket spending, and informal care, measured over the last 5 years of life; and out-of-pocket spending as a proportion of household wealth.Average total cost per decedent with dementia ($287 038) was significantly greater than that of those who died of heart disease ($175 136), cancer ($173 383), or other causes ($197 286) (P < 0.001). Although Medicare expenditures were similar across groups, average out-of-pocket spending for patients with dementia ($61 522) was 81% higher than that for patients without dementia ($34 068); a similar pattern held for informal care. Out-of-pocket spending for the dementia group (median, $36 919) represented 32% of wealth measured 5 years before death compared with 11% for the nondementia group (P < 0.001). This proportion was greater for black persons (84%), persons with less than a high school education (48%), and unmarried or widowed women (58%).Imputed Medicaid, private insurance, and informal care costs.Health care expenditures among persons with dementia were substantially larger than those for other diseases, and many of the expenses were uncovered (uninsured). This places a large financial burden on families, and these burdens are particularly pronounced among the demographic groups that are least prepared for financial risk.National Institute on Aging.

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Chemotherapy Use in the Months Before Death and Estimated Costs of Care in the Last Week of Life.

Publications

Chemotherapy Use in the Months Before Death and Estimated Costs of Care in the Last Week of Life.

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