The end of life costs for Medicare patients with advanced ovarian cancer

Urban, Renata R.; He, Hao; Alfonso, R.; Hardesty, Melissa M.; Goff, Barbara A.

doi:10.1016/j.ygyno.2017.11.022

Cited by 20 publications

(15 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The percentages for chemotherapy use in the last months of life in our cohort are lower than those reported in a large retrospective database study performed in the US including 5509 patients [6]. Several, mainly smaller, studies reported chemotherapy treatment in the last 14 days of life, with percentages varying between 5 and 13% [10][11][12][13][14][15], whereas it was 12% in the last month of life in our study.…”

Section: Discussioncontrasting

confidence: 89%

“…Almost a quarter of patients were admitted to hospital in the last month of life. This percentage is lower than those previously reported, which ranged from 43% to 57% [6,10]. Approximately 10% of patients visited the ER in the last month of life, which can be considered low.…”

Section: Discussioncontrasting

confidence: 68%

“…Several large registry-based studies from the United States (US) show high rates of medical care in the final months of life in patients with ovarian cancer, including chemotherapy administrations, ER visits, hospital admissions and ICU admissions [5,6]. There is only one, small, retrospective study in which end-of-life care in European patients was analysed.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

End-of-life care for patients with advanced ovarian cancer in the Netherlands: A retrospective registry-based analysis.

Broekman

Nijman

et al. 2022

JCO

View full text Add to dashboard Cite

e17612 Background: Patients with advanced ovarian cancer have a poor prognosis and can experience debilitating abdominal symptoms in the last phase of life. Several analyses, mainly performed in the United States (US), show high rates of chemotherapy administration, and emergency room and hospital visits near the end-of-life in this patient category. No large European studies are available, while the organisation of palliative care differs between the US and Europe and between European countries. We aimed to analyse the intensity of inpatient care near the end-of-life in the Netherlands and perform a cross-study comparison with previous reports. Methods: All patients with ovarian cancer that died in 2016 and 2017 were identified from the database of the foundation Dutch Hospital Data (DHD). For the last six months of life the following parameters of aggressive care were extracted: administration of chemotherapy, emergency room (ER) visits, surgical procedures, hospital and intensive care unit (ICU) admissions. Data were analysed for the cohort as a whole and separately for three age categories: < 60, 60-75 and > 75 years of age. The intensity of inpatient care was compared to previously reported European and US data. Results: A total of 2172 patients died with ovarian cancer in 2016 and 2017 in the Netherlands. Data on medical care use was available for 1775 patients. During the last 6 months of life, chemotherapy was given to half of the ovarian cancer patients and the same percentage of patients was admitted to hospital. Chemotherapy administration near the end-of-life was infrequent, with only 12% of patients receiving chemotherapy in the last month of life. Surgery and ICU admissions in the final 6 months of life were rare (< 10%). Our cohort showed the lowest percentages of all five indicators of aggressive care reported thus far. The use of chemotherapy in the six months prior to death was highest in patients 60-75 years of age compared to younger or older patients. ER visits and hospital admissions were less frequent in patients > 75 years of age compared to the younger age groups. Conclusions: Aggressive medical care use in the final 6 months of life in this Dutch cohort of ovarian cancer patients was lower than in other previously reported cohorts.

show abstract

Section: Discussioncontrasting

confidence: 89%

Section: Discussioncontrasting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

End-of-life care for patients with advanced ovarian cancer in the Netherlands: A retrospective registry-based analysis.

Broekman

Nijman

et al. 2022

JCO

View full text Add to dashboard Cite

show abstract

“…Methods for improvement in value-based measures of care, although not specifically addressed in our data set, should be further explored. As quality becomes the focus of reimbursement, value-based measures and assessments are required to improve costs while maximizing patient outcomes [19][20][21]. Specific to gynecologic oncology care, prior studies have demonstrated the feasibility of providing low-cost care to underserved women, though none included a fellow training clinic [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

A fellow-run clinic achieves similar patient outcomes as faculty clinics: A safe and feasible model for gynecologic oncology fellow education

Buchanan¹,

Johns

Massad³

et al. 2020

Gynecologic Oncology

View full text Add to dashboard Cite

Objectives: Fellow involvement in patient care is important for education, but effect on patient care is unclear. Our aim was to compare patient outcomes in gynecologic oncology attending clinics versus a fellow training clinic at a large academic medical center. Methods:A retrospective review of consecutive gynecologic oncology patients from six attending clinics and one faculty-supervised fellow clinic was used to analyze differences based on *

show abstract

“…Although ovarian cancer represents only 2.5% of malignancies among women in the US,4 it has an outsized cost compared with other gynecologic malignancies 3 5. Several factors which seem to drive high overall costs after ovarian cancer diagnosis include inpatient hospitalizations, outpatient services, and drug costs 5–8…”

Section: Introductionmentioning

confidence: 99%

Temporal trends of healthcare system use between symptomatic presentation and ovarian cancer diagnosis in the United States

Huepenbecker

Sun

et al. 2022

Int J Gynecol Cancer

View full text Add to dashboard Cite

ObjectiveTo describe trends in healthcare system use over time between onset of classic ovarian cancer symptoms and ovarian cancer diagnosis in the United States.MethodsA population-based study of the Surveillance, Epidemiology, and End Results-Medicare database was conducted on patients aged ≥66 years with stage II–IV epithelial ovarian cancer between 1992 and 2015 with at least one of the following diagnosis codes: abdominal pain, bloating, difficulty eating, and/or urinary symptoms. The outcomes were frequency of visit type, frequency of diagnostic modality, and Medicare reimbursement between first symptomatic claim and cancer diagnosis. Jonckheere-Terpstra and Cochran-Armitage tests were used to evaluate trends over time.ResultsAmong 13 872 women, 13 541 (97.6%) had outpatient, 6466 (46.6%) had inpatient, and 4906 (35.4%) had emergency room visits. The frequency of outpatient (p<0.001) and emergency room visits (p<0.001) increased while the frequency of inpatient visits (p<0.001) decreased between 1992 and 2015. The median number of outpatient visits (p<0.001) and physician specialties seen (p<0.001) increased over time. The median hospital length of stay decreased from 10 days in 1992 to 5 days in 2015 (p<0.001). Between 1992 and 2015, the frequency of ultrasound decreased (p<0.001) while the frequency of computed tomography, magnetic resonance imaging, positron emission tomography imaging, and cancer antigen 125 tumor immunoassay increased (p<0.001). Median monthly total (p<0.001), inpatient (p<0.001), and outpatient (p=0.006) reimbursements decreased while emergency room reimbursements increased (p<0.001) over time.ConclusionHealthcare reimbursement between symptomatic presentation and ovarian cancer diagnosis has decreased over time and may reflect the trends in fewer and shorter hospitalizations and increased use of emergency and outpatient management during the evaluation of symptoms of women with ovarian cancer.

show abstract

The end of life costs for Medicare patients with advanced ovarian cancer

Cited by 20 publications

References 29 publications

End-of-life care for patients with advanced ovarian cancer in the Netherlands: A retrospective registry-based analysis.

End-of-life care for patients with advanced ovarian cancer in the Netherlands: A retrospective registry-based analysis.

A fellow-run clinic achieves similar patient outcomes as faculty clinics: A safe and feasible model for gynecologic oncology fellow education

Temporal trends of healthcare system use between symptomatic presentation and ovarian cancer diagnosis in the United States

Contact Info

Product

Resources

About