End-of-life care resource utilization: A single provider perspective

Abstract

16022 Background: Most cancer physicians are aware that significant resources are spent in the last year of life but they are provided little feedback on cost or yield of care. Awareness of resource allocation for patients near the end of life may influence physician conversation with patients and families, treatment recommendations, and hospice referral. Methods: UWHealth cancer registry data were used to identify 90 patients who had died in a recent three year period and were cared for at least in part by the medical oncologist being evaluated. Health services utilization within UWHealth (hospital and hospital based clinic sites) was assessed for the last 6 months of life in 66 patients where a clear date of death could be identified. Data included in- and out-patient, pharmacy, laboratory, radiation and imaging services. Hospice charges are not included. Results: In the last 6 months of life, radiology, radiation therapy and pharmacy charges made up 52% of the total. Use of CT, MRI and palliative radiation increased near the end of life. In the last two months of life, 47% of the entire pharmacy charges were spent. In-patient services were greatly increased in the last month of life. Overall charges and more expensive services were highest in the last month of life. Conclusions: Care near the end of life is expensive. This review targeting patients affiliated with one medical oncologist at a large academic health center showed that radiology, radiotherapy, and pharmacy charges involved more than half the total accrued in the last 6 months of life. Feedback such as this if routinely provided to individual oncologists and disease oriented teams may generate strategies for improving end of life care. Even if expensive, some services may be helpful and necessary, others may not. Discussion regarding accountability for resource allocation within the multidisciplinary setting of cancer care may aid in developing improved end of life approaches for patients. No significant financial relationships to disclose.