OBJECTIVES: Although many controversies around quality of care at the end-of-life (EOL) and its aggressiveness have sprung, only few studies have examined how healthcare utilization in patients with hematologic malignancies (HM) is different from those with solid tumors (ST) at the end of life care in the real world setting.

METHODS: We conducted retrospective analysis using National Health Insurance Database (NHID) obtained from 2006 to 2015. Only patients who died of cancer have included. Monthly medical expenditure spent for detailed purposes, such as outpatient (OP) fee, hospitalization cost, and medication, per person were collected at the EOL, defined as 1 year before death, in order to compare cost trend between two cancer types. We also reviewed on medication usage by pre-defined therapeutic categories and healthcare utilization such as the number of OP and emergency room (ER) visits, blood transfusion, cardiopulmonary resuscitation, length of stay (LOS) and LOS in intensive care unit (ICU) per month.

RESULTS: Among 8,719 patients who died because of cancer, 349 (4%) were HM patients and 8,370 (96%) were ST patients. Overall 1–year cost trends in HM patients fluctuated, while those of ST patients showed gradual trend. Monthly medical expenditure spent at the last month before death (MBD) in HM patients was 2.7 times higher than that in ST patients. Among total cost, medication accounted for 54.8% in HM patients compared to 34.2% in ST patients. The cost spent for anticancer drugs, antibiotics, narcotics, blood preparation were higher in HM patients compared to ST patients at the last MBD. The proportion of patients who received anticancer drugs, blood transfusion, cardiopulmonary resuscitation was higher in HM patients at the last MBD (39.3% vs 26.1%; p<0.01, 57.6% vs 26.2%; p<0.01, 13.8% vs 5.1%; p<0.01).

CONCLUSIONS: We elicited that medical practices for patients with HM are different from those with ST and more aggressive.