Last year of life of adolescent young adult (AYA) oncology patients: Inpatient utilization.

Abstract

e18047 Background: Studies of AYA oncology patients’ end-of-life care utilization are critical as cancer is the leading cause of non-accidental AYA death and end-of-life care contributes significantly to healthcare expenditures. We sought to determine the quantity of and disparities in inpatient utilization in the last year of life of AYAs with cancer. Methods: Using the California Office of Statewide Health Planning and Development administrative database linked to death certificates, we performed a retrospective population-based analysis of cancer patients aged 15-39 who died between 2000 and 2011. We determined the number of hospital days and inpatient costs for each patient in their last year of life. We determined clinical and socio-demographic factors associated with high inpatient utilization. We also evaluated admission patterns (frequency and location) as death approached. Results: The 12,883 patients were admitted an average of 40 days in their last year of life, resulting in $149,307 per patient in inpatient costs [non last year of life AYA oncology: 11.6 days (p < 0.01) and $43,423 (p < 0.01)]. As death approached, admission rates and the percent of admissions at non-specialty centers increased. Five percent of patients used 20% of bed-days in the last year (high-utilizers). Sociodemographic and clinical factors associated with high utilization included younger age (15-21y: OR = 2.85; 95% CI, 2.3-3.6, 22-30y: OR = 1.81; 95% CI, 1.5-2.2, reference: 31-39y), Hispanic ethnicity (OR = 1.51; 95% CI, 1.2-1.9, reference: Non-Hispanic White), non-HMO insurance (private: OR = 1.48; 95% CI, 1.1-2.0, public/self pay: OR = 1.84; 95% CI 1.3-2.5), and hematologic malignancies (OR = 3.11; 95% CI 2.6-3.8, reference: solid tumors). Conclusions: AYA oncology decedents spent 40 days in the hospital in their last year of life, with average costs approaching $150,000 per patient. Subgroup with high utilization had distinct sociodemographic and clinical characteristics and non-specialty center admissions increased as death approached. This demonstrates the need for availability of palliative care at non-specialty centers. Whether these disparities and admission patterns represent goal-concurrent care needs to be examined.