End-of-life care for elderly patients with advanced lung cancer in the United States and Ontario.

Abstract

6021 Background: Although the health care systems in the U.S. and Canada differ, both have government-sponsored health insurance for the elderly. Approaches to end of life care also vary between the U.S., which offers Medicare's comprehensive hospice program, and Canada, which has a fragmented system of palliative care. Little research has compared end of life care for elderly in the two countries. Purpose: To compare the types and intensity of end of life care in elderly non-small cell lung cancer (NSCLC) patients in the U.S. and the province of Ontario, Canada. Methods: The linked SEER-Medicare data were used to identify care for 12,198 NSCLC patients with advanced disease at diagnosis who died of cancer between 1999 and 2003 in the U.S. Comparable NSCLC patients (n = 8,100) from the Ontario Cancer Registry were linked with their health claims. Outcomes evaluated were use of chemotherapy, ER visits, inpatient hospitalizations, supportive care, and deaths in hospital. Rates of service use were estimated ...