Targeted Therapy at the End-of-Life and the Impact on Healthcare Utilization (S807)

Abstract

•Describe the use of targeted therapy in cancer treatment at the end-of-life.•Identify the patterns of healthcare utilization observed at the end-of-life for those treated with chemotherapy and targeted therapies. The use of targeted therapy has steadily increased over the past decade, though the impact of targeted agents on patterns of care at the end-of-life remains unknown. To explore the influence of targeted therapy on end-of-life care in a large population-based database. We identified 14,398 patients from the SEER-Medicare linked database with metastatic breast, lung, or colorectal cancer diagnosed between 2000 and 2009 who received conventional cytotoxic chemotherapy or targeted therapy in the last 3 months of life. Multivariate logistic and linear regression models were used to determine the impact of targeted therapy on the following endpoints in the last 3 months: emergency department (ED) visits, hospitalizations, and hospice utilization. Analyses were adjusted for differences in patient age, gender, race, comorbidity, socioeconomic status, and geography. Among the whole study cohort 83% of patients received chemotherapy alone, 12% received chemotherapy with targeted therapy, and 5% received targeted therapy alone. The delivery of any targeted therapy in the last 3 months increased across the study period, from 1.5% in 2000 to 28% in 2009. Compared to patients treated with chemotherapy alone, those treated with targeted therapy alone had lower rates of ED visits (adjusted odds ratio [aOR]=0.81, p=0.01), lower rates of hospitalization (adjusted odds ratio [aOR]=0.69, p<0.0001), no difference in overall hospice utilization rates, though had longer stays on hospice (5.1 days longer, p<0.0001). Compared to patients treated with chemotherapy alone, those treated with both chemotherapy and targeted therapy had no difference in ED visits or hospitalizations, though had decreased rates of hospice utilization (aOR = 0.79, p<0.0001), and shorter stays on hospice (2.7 days shorter, p<0.0001). This study found that targeted therapy was associated with varying patterns of healthcare utilization at the end-of-life.