Aggressive End-of-Life Care among Non-Small Cell Lung Cancer Medicare Patients
Author(s)
Olayiwola Popoola, PhD1, Sandra Suther, PhD1, Matthew Dutton, PhD1, Rima Tawk, PhD1, Karam Diaby, BSc, MSc, PhD2, Askal Ayalew Ali, BA, MA, PhD3.
1Florida A&M University, Tallahassee, FL, USA, 2Otsuka Pharmaceutical Inc, Princeton, NJ, USA, 3Associate Professor, Florida A & M University, Tallahassee, FL, USA.
1Florida A&M University, Tallahassee, FL, USA, 2Otsuka Pharmaceutical Inc, Princeton, NJ, USA, 3Associate Professor, Florida A & M University, Tallahassee, FL, USA.
OBJECTIVES: To examine the use of aggressive end-of-life care for Medicare patients with non-small cell lung cancer (NSCLC).
METHODS: We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) and Medicare data for non-small cell lung cancer (NSCLC) patients 65 years diagnosed and died between January 2015 and December 2020. Aggressive end-of-life care was the receipt of either systemic therapy in the last 14 days of life, more than one hospitalization in the last 30 days of life, intensive care unit admission in the last 30 days of life, or less than 3 days of hospice admission before death.
RESULTS: Among 4,599 NSCLC patients, the mean age at diagnosis was 74.5 years, 49.2% were female, and 79.2% were white. 42.3% (1,955) of the study cohort had an aggressive care indicator at the end of life, of which 60% (1,169) had an ICU admission in the last 30 days of life, 32.8% (637) had less than three days hospice admission. In the multivariate analysis, being black OR 1.49 (95% CI, 1.17 -1.91), Asian OR 1.73 (95% CI, 1.25 - 2.06), being married OR 1.241 (95% CI, 1.092 - 1.41), having two or more Charleston comorbidity index (CCI) OR 1.23 (95% CI, 1.07 - 1.42) were significantly associated with a higher likelihood of receiving aggressive care at the end of life. Being older OR 0.98 (95% CI, 0.97 - 0.99), being stage IV at diagnosis OR 0.72 (95% CI, 0.60 - 0.87), being on the second length of stay (LOT) OR 0.72 (95% CI, 0.61 - 0.86), and follow-up duration above six months was less likely associated with receiving aggressive care at the end of life.
CONCLUSIONS: This study found that nearly half of NSCLC elderly patients receive aggressive end-of-life care, which increases the cost of care at the end of life.
METHODS: We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) and Medicare data for non-small cell lung cancer (NSCLC) patients 65 years diagnosed and died between January 2015 and December 2020. Aggressive end-of-life care was the receipt of either systemic therapy in the last 14 days of life, more than one hospitalization in the last 30 days of life, intensive care unit admission in the last 30 days of life, or less than 3 days of hospice admission before death.
RESULTS: Among 4,599 NSCLC patients, the mean age at diagnosis was 74.5 years, 49.2% were female, and 79.2% were white. 42.3% (1,955) of the study cohort had an aggressive care indicator at the end of life, of which 60% (1,169) had an ICU admission in the last 30 days of life, 32.8% (637) had less than three days hospice admission. In the multivariate analysis, being black OR 1.49 (95% CI, 1.17 -1.91), Asian OR 1.73 (95% CI, 1.25 - 2.06), being married OR 1.241 (95% CI, 1.092 - 1.41), having two or more Charleston comorbidity index (CCI) OR 1.23 (95% CI, 1.07 - 1.42) were significantly associated with a higher likelihood of receiving aggressive care at the end of life. Being older OR 0.98 (95% CI, 0.97 - 0.99), being stage IV at diagnosis OR 0.72 (95% CI, 0.60 - 0.87), being on the second length of stay (LOT) OR 0.72 (95% CI, 0.61 - 0.86), and follow-up duration above six months was less likely associated with receiving aggressive care at the end of life.
CONCLUSIONS: This study found that nearly half of NSCLC elderly patients receive aggressive end-of-life care, which increases the cost of care at the end of life.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HSD4
Topic
Health Service Delivery & Process of Care
Disease
SDC: Oncology