Acute Hospital Care Is The Chief Driver Of Regional Spending Variation In Medicare Patients With Advanced Cancer

Brooks, Gabriel A.; Li, Ling; Uno, Hajime; Hassett, Michael J.; Landon, Bruce E.; Schrag, Deborah

doi:10.1377/hlthaff.2014.0280

Cited by 111 publications

(111 citation statements)

References 26 publications

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“…Consistent with prior work 10,11 and to identify individuals diagnosed with cancer at stages for which treatment is typically palliative, 3,4 advanced stage was defined as stage IV for all cancers, stage IIIB for nonsmall-cell lung cancer (NSCLC), and stage III for pancreatic cancer (Appendix Table A1, online only). Data for individuals younger than 18 years old at diagnosis (n = 3), those who were missing or had duplicate variables needed for OSHPD linkage (n = 2,378), and those for whom date of death was missing or recorded as the same day as diagnosis (n = 58) were excluded.…”

Section: Samplementioning

confidence: 99%

“…Inpatient care drives regional variation in costs for advanced cancer care, which suggests that health system factors or local practice patterns, rather than clinical need alone, may drive care provision to some extent. 10 In addition, planned hospitalizations for individuals with advanced cancer may be considered potentially avoidable in cases for which improved communication about prognosis, advanced care planning, and Covariates included the following: age, sex, race/ethnicity, insurance status, marital status, area-based socioeconomic status quintile (SES), 28 and comorbidities (Table 1). Hospital characteristics, derived from the 2012 OSHPD Hospital Annual Utilization Report, included the following: hospital size, ownership type, presence of a teaching program, and presence of an outpatient palliative care program (described in the Appendix, online only).…”

Section: Outcomes and Variable Definitionsmentioning

confidence: 99%

“…Among individuals with advanced cancer, inpatient care accounts for a majority of cancer-related spending 8,9 and drives regional spending variation. 10 Moreover, there is no apparent association between spending and survival. 11 Taken together, the high cost of and excessive variability in inpatient cancer care suggest that interventions to reduce unnecessary hospitalizations may reduce costs and improve quality of life in this population.…”

Section: Introductionmentioning

confidence: 99%

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Hospitalization Rates and Predictors of Rehospitalization Among Individuals With Advanced Cancer in the Year After Diagnosis

Whitney

Bell

Tancredi

et al. 2017

JCO

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Among individuals with advanced cancer, frequent hospitalization increasingly is viewed as a hallmark of poor-quality care. We examined hospitalization rates and individual-and hospital-level predictors of rehospitalization among individuals with advanced cancer in the year after diagnosis. MethodsIndividuals diagnosed with advanced breast, colorectal, non-small-cell lung, or pancreatic cancer from 2009 to 2012 (N = 25,032) were identified with data from the California Cancer Registry (CCR).After linkage with inpatient discharge data, multistate and log-linear Poisson regression models were used to calculate hospitalization rates and to model rehospitalization in the year after diagnosis, accounting for survival. ResultsIn the year after diagnosis, 71% of individuals with advanced cancer were hospitalized, 16% had three or more hospitalizations, and 64% of hospitalizations originated in the emergency department. Rehospitalization rates were significantly associated with black non-Hispanic (incidence rate ratio [IRR], 1.29; 95% CI, 1.17 to 1.42) and Hispanic (IRR, 1.11; 95% CI, 1.03 to 1.20) race/ ethnicity; public insurance (IRR, 1.37; 95% CI, 1.23 to 1.47) and no insurance (IRR, 1.17; 95% CI, 1.02 to 1.35); lower socioeconomic status quintiles (IRRs, 1.09 to 1.29); comorbidities (IRRs, 1.13 to 1.59); and pancreatic (IRR, 2.07; 95% CI, 1.95 to 2.20) and non-small-cell lung (IRR, 1.69; 95% CI, 1.54 to 1.86) cancers versus colorectal cancer. Rehospitalization rates were significantly lower after discharge from a hospital that had an outpatient palliative care program (IRR, 0.90; 95% CI, 0.83 to 0.97) and were higher after discharge from a for-profit hospital (IRR, 1.33; 95% CI, 1.14 to 1.56). ConclusionIndividuals with advanced cancer experience a heavy burden of hospitalization in the year after diagnosis. Efforts to reduce hospitalization and provide care congruent with patient preferences might target individuals at higher risk. Future work might explore access to palliative care in the community and related health care use among individuals with advanced cancer.

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Section: Samplementioning

confidence: 99%

Section: Outcomes and Variable Definitionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hospitalization Rates and Predictors of Rehospitalization Among Individuals With Advanced Cancer in the Year After Diagnosis

Whitney

Bell

Tancredi

et al. 2017

JCO

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“…Disease-and treatment-related morbidity leading to hospitalization is particularly relevant [5,6], given that inpatient admission is associated with reduced quality of life among patients with incurable cancer including glioblastoma [7,8], as well as growing calls to reduce readmissions from quality-of-care and costcontainment perspectives [9,10]. Prior studies have reported on treatment tolerance specifically in the elderly glioblastoma population [11][12][13][14], and randomized trials have profiled adverse events among patients eligible for clinical trial inclusion [2].…”

Section: Introductionmentioning

confidence: 99%

Incidence, risk factors, and reasons for hospitalization among glioblastoma patients receiving chemoradiation

et al. 2015

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Despite a high symptom burden, little is known about the incidence or predictors of hospitalization among glioblastoma patients, including risks during chemoradiation (CRT). We studied 196 consecutive newly diagnosed glioblastoma patients treated at our institution from 2006-2010. Toxicity data were reviewed during and after the CRT phase, defined as the period between diagnosis and 6 weeks after radiotherapy completion. Logistic regression and proportional hazards modeling identified predictors of hospitalization and overall survival (OS). Median age was 59 years (range, 23-90) and 83 % had Karnofsky performance status (KPS) score ≥ 70. Twenty-six percent of patients underwent gross total resection, 77 % received ≥ 59.4 Gy of radiotherapy, and 89 % received concurrent temozolomide. Median OS was 15.6 months (IQR, 8.5-26.8 months). Forty-three percent of patients were hospitalized during the CRT phase; OS was 10.7 vs. 17.8 months for patients who were vs. were not hospitalized, respectively (P < .001). Nearly half of the hospitalizations were due to generalized weakness (17 % of hospitalizations), seizures (16 %), or venous thromboembolism (13 %). On multivariate analysis, age (odds ratio [OR], 1.03; 95 % CI, 1.002-1.060; P = .034) and KPS (OR, 0.95; 95 % CI, 0.93-0.97; P < .001) were associated with risk of hospitalization. Hospitalization during the CRT phase was associated with decreased OS (adjusted hazard ratio, 1.47; 95 % CI, 1.01-2.13; P = .043), after adjustment for known prognostic factors. Hospitalization during the CRT phase is common among glioblastoma patients in the temozolomide era and is associated with shorter overall survival.

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“…# Platelets <150 ×1,000/µL, GFR <60 mL/min, calcium <2.15 mg/dL, and white blood cell count <4.2 ×1000/µL predicted chemotherapy-related hospitalization in patients receiving palliative chemotherapy [12]. Color version available online patients with advanced cancer [25]. In this cohort, the hospitalization rate was high.…”

Section: Discussionmentioning

confidence: 84%

Oncologic Response and Hospitalization Rate of Patients Receiving Cabazitaxel in the Fourth-Line and Beyond in Castration-Resistant Prostate Cancer: Analysis of a Retrospective Cohort and a Structured Literature Review

Hardenberg

Schwartz²,

Werner³

et al. 2017

Urol Int

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Background: Limited data are available for the use of agents in metastatic castration-resistant prostate cancer (mCRPC) beyond the third-line. We provide data during treatment with cabazitaxel (CAB), helping to improve the informed-consent process. Patients and Methods: We retrospectively reviewed patients treated with fourth-line or beyond CAB for mCRPC after failure of previous therapies with docetaxel, abiraterone acetate, enzalutamide and/or radium-223. The progression-free survival (PFS) and the overall survival (OS) were estimated using the Kaplan-Meier method and compared to published data based on a structured literature review. The hospitalization rate was recorded. Factors influencing 6-months OS were analyzed. Results: Fifteen patients were identified at 4 institutions and included in the analysis. The median PFS was 104 days (range 47-397 days). The median time to death was 10 months (range 2-16). PFS and OS data are in accordance with 17 published patients so far. During the therapy, eleven (73%) of the patients were hospitalized. Prostate-specific antigen (PSA, 500 units; hazards ratio [HR] 1.491, 95% CI 1.000-2.0175), white blood cell count (HR 0.425, 95% CI 0.108-0.952), hemoglobin (HR 0.6014, 95% CI 0.2942-1.0758), and alkaline phosphatase (100 units; HR 1.0964, 95% CI 1.000-1.2859) correlate with 6-months OS. Conclusions: CAB beyond the third-line is often accompanied by hospitalization. PFS is a significant proportion of the median time of OS. The baseline laboratory might be a good indicator for the decision between CAB and best-supportive care.

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Acute Hospital Care Is The Chief Driver Of Regional Spending Variation In Medicare Patients With Advanced Cancer

Cited by 111 publications

References 26 publications

Hospitalization Rates and Predictors of Rehospitalization Among Individuals With Advanced Cancer in the Year After Diagnosis

Hospitalization Rates and Predictors of Rehospitalization Among Individuals With Advanced Cancer in the Year After Diagnosis

Incidence, risk factors, and reasons for hospitalization among glioblastoma patients receiving chemoradiation

Oncologic Response and Hospitalization Rate of Patients Receiving Cabazitaxel in the Fourth-Line and Beyond in Castration-Resistant Prostate Cancer: Analysis of a Retrospective Cohort and a Structured Literature Review

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