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:10.1097/01.ogx.0000530382.06730.2e

Cited by 4 publications

(7 citation statements)

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“…We also found that being of black or Hispanic race/ethnicity was associated with higher amounts paid by Medicare during the final year, six months and 30 days of life. A recent publication assessing the cost of care at the end of life among ovarian cancer patients reported similar end of life costs to our analysis, supporting the accuracy of our estimates of costs [36]. Given the percentage of patients who elected to unenroll from hospice and undergo more invasive care, this finding of losing the reduction in the amount paid by Medicare is not surprising.…”

Section: Discussionsupporting

confidence: 84%

How we use hospice: Hospice enrollment patterns and costs in elderly ovarian cancer patients

Taylor

Zhang

Rajan³

et al. 2019

Gynecologic Oncology

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To describe disparities in patterns of hospice use and end-of-life costs among ovarian cancer patients. Methods. Using Texas Cancer Registry-Medicare data, ovarian cancer patients deceased 2005-2012 with N12 months of continuous Medicare coverage before death were included. Descriptive statistics and multivariable logistic regressions were used to evaluate patterns of hospice use. Cost and resource utilization was obtained from Medicare claims and analyzed using a non-parametric Mann-Whitney test. Results. 2331 patients were assessed: 1788 (77%) white, 359 (15%) Hispanic, 158 (7%) black and 26 (1%) other. 1756 (75%) enrolled in hospice prior to death but only 1580 (68%) died with hospice. 176 (10%) of 1756 patients unenrolled and died without hospice. 346 (20%) unenrolled from hospice multiple times. From 2008 to 2012, patients were less likely to unenroll from hospice prior to death. Black patients were more likely to unenroll from hospice prior to death (OR 2.07 [1.15-3.73]; p = 0.02) compared to white patients. The median amount paid by Medicare during the last six months of life was $38,530 for those in hospice compared to $49,942 if never enrolled in hospice (p b 0.0001) and was higher for black and Hispanic patients compared to white patients. 30% hospice unenrolled patients and 40% multiply enrolled hospice patients received at least one life extending or invasive care procedure following unenrollment from hospice. Conclusion. Recently, more patients remain enrolled in hospice, but black patients have a higher risk of unenrollment. Hospice enrollment was associated with lower costs as long as a patient did not unenroll from hospice.

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Section: Discussionsupporting

confidence: 84%

How we use hospice: Hospice enrollment patterns and costs in elderly ovarian cancer patients

Taylor

Zhang

Rajan³

et al. 2019

Gynecologic Oncology

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“…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%

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

Broekman¹,

Aa²,

Nijman³

et al. 2022

Gynecologic Oncology

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“…The American Society of Clinical Oncology (ASCO), the National Comprehensive Cancer Network (NCCN), as well as other national organizations have identified end of life care as a national priority and a core tenant of quality cancer care 16 17. As symptom management and avoidance of futile interventions are crucial at the end of life,18 19 it is important to evaluate whether trial participation encourages high intensity care prior to death. Our results differ from those presented in a prospective study of 358 patients with non-gynecologic cancers in which clinical trial participants experienced higher rates of aggressive end of life care in addition to chemotherapy administration 12.…”

Section: Discussionmentioning

confidence: 99%

Clinical trial participation and aggressive care at the end of life in patients with ovarian cancer

Nitecki

Bercow

Gockley

et al. 2020

International Journal of Gynecological Cancer

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ObjectivesIn non-gynecologic cancers, clinical trial participation has been associated with aggressive care at the end of life. The objective of this investigation was to examine how trial participation affects end of life outcomes in patients with ovarian cancer.MethodsIn a retrospective review of women diagnosed with ovarian cancer at our institution between January 2010 and December 2015, we collected variables identified by the National Quality Forum as measures of aggressive end of life care including chemotherapy in the last 14 days of life, intensive care unit (ICU) admission in the last 30 days of life, or death in the acute care setting. Trials investigating medications but not surgical interventions were included. The primary outcome of this study was the association between trial participation and the National Quality Forum measures of aggressive end of life care in ovarian cancer decedents. Data were analyzed with univariable and multivariable parametric and non-parametric testing, and time to event outcomes were analyzed using the Kaplan–Meier method and Cox’s proportional hazard models.ResultsAmong 391 women treated for ovarian cancer, 62 patients (16%) participated in a clinical trial. Patients enrolled in clinical trials were more likely to have chemotherapy administered within 14 days of death; however, no association was found with other metrics of aggressive care at the end of life including the initiation of a new chemotherapy regimen in the last 30 days of life, ICU admissions, and death in an acute care setting. Among patients with recurrent ovarian cancer, median overall survival for trial participants was 57 months compared with only 31 months in non-trial participants (p<0.001).ConclusionsIn patients with ovarian cancer, clinical trial enrollment is associated with chemotherapy administration within 14 days of death, but not other measures of aggressive care at the end of life. Given the importance of clinical trial participation in improving care for women with ovarian cancer, this study suggests that concerns regarding aggressive care prior to death should not limit clinical trial participation.

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The End of Life Costs for Medicare Patients With Advanced Ovarian Cancer

Abstract: (Abstracted from Gynecol Oncol 2018;148:336–341) Most patients with advanced ovarian cancer will ultimately die of the disease. End-of-life care for ovarian cancer patients is often associated with a considerable expenditure of resources and costs.

Cited by 4 publications

References 0 publications

How we use hospice: Hospice enrollment patterns and costs in elderly ovarian cancer patients

How we use hospice: Hospice enrollment patterns and costs in elderly ovarian cancer patients

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

Clinical trial participation and aggressive care at the end of life in patients with ovarian cancer

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