Disparities in location of death of adolescents and young adults with cancer: A longitudinal, population study in California

Rajeshuni, Nitya; Johnston, Emily E.; Saynina, Olga; Sanders, Lee; Chamberlain, Lisa

doi:10.1002/cncr.30860

Cited by 23 publications

(39 citation statements)

References 36 publications

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“…In contrast, Hispanic ethnicity significantly increased the odds of PICU death within this large PPO patient population. Ethnic disparities involving location of death for children with cancer have been suggested by two prior studies, in which Hispanic patients were more likely to die in the hospital setting compared with non-Hispanic patients [26,27]. Our findings suggest that these disparities may extend across the PPO population as well.…”

Section: Discussionsupporting

confidence: 65%

“…A previous study conducted at this institution 8 years ago likewise showed that race did not affect EOL care planning or resuscitation status for children with cancer, but that study did not query potential disparities related to location of death [25]. To our knowledge, only two other studies have investigated the effect of race on location of death specifically in pediatric patients with cancer, in which black children, adolescents, and young adults were more likely to die in the hospital [26,27]. The lack of racial disparities identified in the two studies out of this institution may speak to broad financial interventions that level the socioeconomic playing field for all comers at this cancer center; however, further research is needed to explore this hypothesis and better describe racial disparities around EOL care for PPO patients and their families.…”

Section: Discussionmentioning

confidence: 93%

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Predictors of Location of Death for Children with Cancer Enrolled on a Palliative Care Service

et al. 2018

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Children with cancer who die in high-acuity inpatient settings often experience a high burden of intensive therapy at the end of life. Strategies to identify patients at higher risk of dying in the pediatric intensive care unit (PICU) have not been explored previously. This study finds that certain variables may predict PICU death for pediatric palliative oncology patients, including delayed palliative care involvement. Preemptive identification of patients at risk for PICU death affords opportunities to study the effects of earlier palliative care integration and increased discussions around preferred location of death on end-of-life outcomes for children with cancer and their families.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 93%

Predictors of Location of Death for Children with Cancer Enrolled on a Palliative Care Service

et al. 2018

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“…48 in care for Asian American patients. 52 For example, one study using Medicare claims demonstrated that the hospital death rate for patients with cancer was 22% in 2010 53 ; the current study, which included all patients who died of cancer in the United States in 2010, indicated that this rate was higher at 28%. Although all racial groups demonstrated a temporal decrease for hospital death rates within the last 17 02 03 04 05 06 07 08 09 10 11 12 13 14 15 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 years, the results of the current study highlight that large disparities remain.…”

Section: Discussionmentioning

confidence: 60%

Place of death for patients with cancer in the United States, 1999 through 2015: Racial, age, and geographic disparities

Chino

Kamal

LeBlanc

et al. 2018

Cancer

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BACKGROUND Place of death is an essential component of high quality cancer care and comprehensive national trends and disparities in place of death are unknown. METHODS Deidentified death certificate data were obtained via the National Center for Health Statistics. All cancer deaths from 1999 through 2015 were included. Multivariate logistic regression was used to test for disparities in place of death associated with sociodemographic variables. RESULTS From 1999 through 2015, a total of 9,646,498 cancer deaths occurred. Hospital deaths decreased (from 36.6% to 24.6%), whereas the rate of home deaths (38.4% to 42.6%) and hospice facility deaths (0% to 14.0%) both increased (all P<.001). On multivariate logistic regression, all assessed variables were found to be associated with place of death. Specifically, younger age (age birth‐14 years: odds ratio [OR], 2.39; age 25‐44 years: OR, 1.62), black (OR, 1.83) or Asian (OR, 1.74) race, and Hispanic ethnicity (OR, 1.41) were associated with hospital death. Being married (OR, 2.17) or widowed (OR, 1.56) was associated with home death whereas increasing educational level (OR, 1.15‐1.19) was associated with hospice death (all P<.001). Despite overall improvements, certain disparities were found to increase. For young patients, the likelihood of a hospital death increased from 2.3 times to 3.4 times that of older patients (50.9% for those aged 15‐24 years vs 15.0% for those aged ≥85 years in 2015). For black patients, the likelihood of a hospital death increased from 1.29 times to 1.42 times that of white patients (32.8% for black patients vs 23.1% for white patients in 2015). CONCLUSIONS Hospital cancer deaths decreased by approximately one‐third with commensurate increases in home and hospice facility deaths. Many sociodemographic groups experience significant disparities with regard to place of death and may benefit from targeted efforts to improve goal‐concordant care.

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“…In this context, EOL trajectories represent utilization patterns prior to the EOL in regards to costs, provider visits, hospitalizations, interventions, and general access to the health care system 1. Of the reports that exist, most focus on AYA with cancer 1–5. Roughly three-fourths of young people who die do so in an intensive care setting with numerous burdensome symptoms and distress at the EOL 6.…”

Section: Introductionmentioning

confidence: 99%

“…Even within the adolescent and young adult age group, preliminary evidence suggests that young adults (aged 20–24 years) are at great risk due to care transitions both in providers and insurance coverage, but most of this literature has been limited to those with cancer diagnoses 5,10,11. To our knowledge, examination of hospice care use has not yet been explored for young people who are covered through private insurance.…”

Section: Introductionmentioning

confidence: 99%

An economic examination of private insurance claims among adolescents and young adults who were enrolled in hospice during the last year of life

Keim‐Malpass

Cohrs

Lindley

et al. 2018

AHMT

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PurposeThe purpose of this study was to generate baseline data on the health characteristics, health care utilization, and health care spending among privately insured adolescents and young adults (AYA), who were enrolled in hospice care during their last year of life.MethodsA retrospective, nonexperimental design was used to collect and analyze longitudinal claims data from the Truven Health MarketScan™ database. The sample included AYA (aged 15–24 years) who utilized hospice during their last year of life.ResultsTotally, 17,408 AYA were included in this analysis. Mean hospice length of stay (LOS) was low overall, but there was a statistically significant difference in hospice LOS in ages 15–19 years (mean 3.56, SD 15.17 days) compared with those aged 20–24 years (mean 2.26, SD 8.24; P<0.001 days). More than a third (37%) of the AYAs used the emergency department during the last year of life and 83% sought care from a primary care visit. However, only 6% of the sample who were hospice enrollees used frequent inpatient hospital services.ConclusionsThis study provides preliminary data for private insurance expenditures and clinical utilization for AYA who were enrolled in hospice. This analysis also provides initial evidence to suggest extremely short hospice LOS for AYAs prior to the end of life and represents an area of future research need.

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Disparities in location of death of adolescents and young adults with cancer: A longitudinal, population study in California

Cited by 23 publications

References 36 publications

Predictors of Location of Death for Children with Cancer Enrolled on a Palliative Care Service

Predictors of Location of Death for Children with Cancer Enrolled on a Palliative Care Service

Place of death for patients with cancer in the United States, 1999 through 2015: Racial, age, and geographic disparities

An economic examination of private insurance claims among adolescents and young adults who were enrolled in hospice during the last year of life

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