A POPULATION-BASED STUDY OF RADIOTHERAPY USE IN THE LAST 30 DAYS OF LIFE FOR PATIENTS WITH THORACIC CANCERS IN TAIWAN
Author(s)
Chien c1, Li C1, Chiu BC2, Guadagnolo B(3, Shih YT4
1China Medical University Hospital, Taichung, Taiwan, 2Chicago University, Chicago, IL, USA, 3University of Texas MD Anderson Cancer Center, Houston, TX, USA, 4The University of Texas MD Anderson Cancer Center, Houston, TX, USA
OBJECTIVES: Overly aggressive cancer treatment toward the end of life (EOL) is considered an indicator of poor-quality care. While radiotherapy can be used to alleviate symptoms arising from cancer, prolonged courses of radiotherapy may subject patients to additional harms. We hypothesized that among patients with thoracic cancers overly aggressive EOL radiotherapy is more likely among younger patients. METHODS: We defined the duration of EOL as the last 30 days of life and used data from the population-based Taiwan cancer registry linked to Taiwan death registry to construct an EOL study cohort from patients diagnosed with lung or esophageal between 2008 and 2010 and died before December 31, 2012. We identified radiotherapy use from the National Health Insurance claims data and conducted logistic regression to compare the EOL radiotherapy use between elderly (≥ 65) and non-elderly cancer patients while controlling for cancer types, gender, region, socioeconomic status, comorbidity, survival duration, and year of death. We calculated the proportion of radiotherapy-related costs in total medical costs in EOL and quantified patients whose proportion was at the top 10% percentile as those with overly aggressive EOL radiotherapy and examine the associated factors with logistic regression. RESULTS: Our study cohort consisted of 17,441 patients. EOL radiotherapy use was reported in10.1% patients, with a higher percentage observed among non-elderly patients (13.77% vs. 8.38%, P<.0001). Non-elderly patients were more likely to receive EOL radiotherapy after controlling for confounders [adjusted odds ratio (AOR): 1.828, 95% CI 1.639 – 2.039]. Among patients with EOL radiotherapy, overly aggressive care was found to be more common among nonelderly patients in unadjusted (11.62% vs. 8.74%, P=0.0461) and adjusted analyses (AOR: 1.526; 95% CI: 1.09 – 2.136). CONCLUSIONS: In thoracic cancers, we found that younger patients are more susceptible to overly aggressive EOL care.
Conference/Value in Health Info
2016-05, ISPOR 2016, Washington DC, USA
Value in Health, Vol. 19, No. 3 (May 2016)
Code
PCN180
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Oncology