Abstract
BackgroundHospice and end‐of‐life health care utilization among patients with esophageal cancer are understudied. We used the Surveillance, Epidemiology, and End Results (SEER)‐Medicare linked database to analyze hospice use and end‐of‐life treatment patterns.MethodsWe included patients diagnosed with esophageal adenocarcinoma or squamous cell carcinoma between 2000 and 2011 and who had died by December 31, 2013. We evaluated patterns of hospice enrollment, chemotherapy receipt, radiation receipt, acute care hospitalizations, and intensive care unit (ICU) admissions at end of life. We used multivariate logistic regression to evaluate possible associations with hospice use, late ICU admission, and late chemotherapy receipt.ResultsOur study included 6449 patients; 3597 (55.8%) enrolled in hospice. Among hospice enrolled patients, 31.4% enrolled in the last 7 days of life. Hospice enrollment increased over time, from 43.2% in 2000 to 59.6% in 2013. Patients who were older, female, with stage IV disease, or those with higher socioeconomic status were more likely to enroll in hospice. Among all patients, 19.1% had an ICU admission within the last 30 days and 4.6% received chemotherapy within the last 14 days of life. Those who were Black or Asian (compared to White), married, or had a comorbidity score >1 were more likely to have a late ICU admission. Males and younger patients were more likely to receive chemotherapy at end of life.ConclusionHospice enrollment rates among patients with esophageal cancer have increased over time; however, a significant percentage of patients enrolls near the end of life. Further research is needed to improve understanding of how end‐of‐life care decisions for these patients are made.
Highlights
Esophageal cancer incidence in the United States has risen over the past 2 decades, with an estimated 16 940 new cases and 15 690 deaths expected in 2017.1,2 Despite recent advances in treatment options, the overall survival outlook for these patients remains poor, with a 5‐year survival of just 18.8%.1 While those with localized disease experience better 5‐year survival rates (42.9%), approximately 39% of patients are diagnosed with metastatic disease.[3]
We aimed to determine which patient and clinical characteristics were associated with hospice enrollment and aggressive end‐of‐life treatment, defined as acute care hospitalizations within the last 30 days, intensive care unit (ICU) admissions within the last 30 days, radiation receipt within the last 14 days, and chemotherapy receipt within the last 14 days of life.[16]
We included patients diagnosed at age 66 or older between January 1, 2000 and December 31, 2011, with esophageal adenocarcinoma (EAC) or esophageal squamous cell (ESC) as the primary cancer, and who had died by December 31, 2013
Summary
Esophageal cancer incidence in the United States has risen over the past 2 decades, with an estimated 16 940 new cases and 15 690 deaths expected in 2017.1,2 Despite recent advances in treatment options, the overall survival outlook for these patients remains poor, with a 5‐year survival of just 18.8%.1 While those with localized disease experience better 5‐year survival rates (42.9%), approximately 39% of patients are diagnosed with metastatic disease.[3]. Esophageal cancer incidence in the United States has risen over the past 2 decades, with an estimated 16 940 new cases and 15 690 deaths expected in 2017.1,2 Despite recent advances in treatment options, the overall survival outlook for these patients remains poor, with a 5‐year survival of just 18.8%.1. While those with localized disease experience better 5‐year survival rates (42.9%), approximately 39% of patients are diagnosed with metastatic disease.[3] as incidence continues to climb, efforts to improve health care delivery and outcomes for these patients are critically needed. We aimed to determine which patient and clinical characteristics were associated with hospice enrollment and aggressive end‐of‐life treatment, defined as acute care hospitalizations within the last 30 days, intensive care unit (ICU) admissions within the last 30 days, radiation receipt within the last 14 days, and chemotherapy receipt within the last 14 days of life.[16]
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