OBJECTIVES: To determine the characteristics of terminal care offered to elderly patients with cancer in Japan.

METHODS: Descriptive epidemiologic study of the data in 2012 based on the National Database of Health Insurance Claims and Specific Health Checkups (NDB) that includes most healthcare claims in Japan. In total, 1873 claims of patients aged 65 or older who died of cancer in hospitals were obtained from a dataset of 142270 inpatient claims that were randomly sampled from the NDB. Main outcomes and measures were length of hospital stay, percentage of admission to intensive care units, length of stay in intensive care units and mean expenditure per admission.

RESULTS: Our study participants comprised 712 (38.0%) females; 574 (30.6%) patients aged 65-74, 805 (43.0%) aged 75-84, and 494 (26.4%) aged 85 or older. Of these, 409 (21.8%) had lung cancer and 295 (15.8%) had stomach cancer. Mean length of hospital stay was 13.6 days (SD, 8.3), and 1023 (54.6%) patients were hospitalized within 30 days before dying. To assess hospital utilization among the study population, we analyzed 104 patient claims for which data were available, finding that 7 (6.7%) patients were admitted to the ICU, for a mean ICU stay of 8.1 days (SD, 3.7). Mean hospital expenditure was 8554 USD (SD, 7359), and mean hospital expenditure per day was 712 USD.

CONCLUSIONS: This study revealed relatively longer hospital stays and higher inpatient expenditures in Japan than those in other developed countries. Further functional differentiation among hospitals and more detailed clinical and political evaluations are needed.