Hospital use at the end-of-life among elderly Medicare beneficiaries diagnosed with poor prognosis cancers.

Abstract

232 Background: Hospital care for patients with cancer near the end of life (EOL) may reflect poor symptom management and be associated with worse quality of life. We quantified hospital use and in-hospital deaths among elderly Medicare beneficiaries with cancer. Methods: Medicare fee-for-service beneficiaries aged ≥65 years diagnosed with poor prognosis cancers, i.e., breast (stage IV), prostate (stage IV), non-small cell lung (NSCLC; stages III-IV), small cell lung (SCLC; all stages), and pancreas (all stages) cancers in 2008-2019 and died of cancer in 2014-2019 were identified from the linked SEER-Medicare data. The number of hospitalizations, intensive care unit (ICU) admissions, and in-hospital deaths during the last six months and last 30-days of life were examined with descriptive statistics (proportions, means, and rates per 100 person-months [PM]) by cancer site. Results: The final sample consisted of 40,304 patients diagnosed with poor prognosis cancers (mean age: 75.0 years). Among patients with pancreas and SCL cancers, nearly half died within 6 months of diagnosis. In contrast, six-month mortality was lower among patients with stage IV breast and prostate cancers. Among all patients in the last 6 months of life, there were 31.2 hospitalizations per 100 PM, with a mean of 2.02 hospitalizations among patients with any hospitalization. In patients with last 30 days of life, 34.7% had any hospitalization. Among hospitalized in the last 30 days, 43.4% were treated in an ICU and 35.2% died in hospital. Hospitalizations were high across all cancer types measured. Conclusions: Utilization of inpatient services among patients diagnosed with poor prognosis cancers is high near the EOL, which suggests sub-optimal care. Future studies should investigate patient and provider factors associated with such utilizations and identify opportunities to improve EOL care.[Table: see text]