TY - JOUR
T1 - Predictors of high-intensity care at the end of life among older adults with solid tumors
T2 - A population-based study
AU - Baird, Courtney E.
AU - Wulff-Burchfield, Elizabeth
AU - Egan, Pamela C.
AU - Hugar, Lee A.
AU - Vyas, Ami
AU - Trikalinos, Nikolaos A.
AU - Liu, Michael A.
AU - Bélanger, Emmanuelle
AU - Olszewski, Adam J.
AU - Bantis, Leonidas E.
AU - Panagiotou, Orestis A.
N1 - Publisher Copyright:
© 2024 Elsevier Ltd
PY - 2024/6
Y1 - 2024/6
N2 - Introduction: High-intensity end-of-life (EoL) care can be burdensome for patients, caregivers, and health systems and does not confer any meaningful clinical benefit. Yet, there are significant knowledge gaps regarding the predictors of high-intensity EoL care. In this study, we identify risk factors associated with high-intensity EoL care among older adults with the four most common malignancies, including breast, prostate, lung, and colorectal cancer. Materials and Methods: Using SEER-Medicare data, we conducted a retrospective analysis of Medicare beneficiaries aged 65 and older who died of breast, prostate, lung, or colorectal cancer between 2011 and 2015. We used multivariable logistic regression to identify clinical, demographic, socioeconomic, and geographic predictors of high-intensity EoL care, which we defined as death in an acute care hospital, receipt of any oral or parenteral chemotherapy within 14 days of death, one or more admissions to the intensive care unit within 30 days of death, two or more emergency department visits within 30 days of death, or two or more inpatient admissions within 30 days of death. Results: Among 59,355 decedents, factors associated with increased likelihood of receiving high-intensity EoL care were increased comorbidity burden (odds ratio [OR]:1.29; 95% confidence interval [CI]:1.28–1.30), female sex (OR:1.05; 95% CI:1.01–1.09), Black race (OR:1.14; 95% CI:1.07–1.23), Other race/ethnicity (OR:1.20; 95% CI:1.10–1.30), stage III disease (OR:1.11; 95% CI:1.05–1.18), living in a county with >1,000,000 people (OR:1.23; 95% CI:1.16–1.31), living in a census tract with 10%–<20% poverty (OR:1.09; 95% CI:1.03–1.16) or 20%–100% poverty (OR:1.12; 95% CI:1.04–1.19), and having state-subsidized Medicare premiums (OR:1.18; 95% CI:1.12–1.24). The risk of high-intensity EoL care was lower among patients who were older (OR:0.98; 95% CI:0.98–0.99), lived in the Midwest (OR:0.69; 95% CI:0.65–0.75), South (OR:0.70; 95% CI:0.65–0.74), or West (OR:0.81; 95% CI:0.77–0.86), lived in mostly rural areas (OR:0.92; 95% CI:0.86–1.00), and had poor performance status (OR:0.26; 95% CI:0.25–0.28). Results were largely consistent across cancer types. Discussion: The risk factors identified in our study can inform the development of new interventions for patients with cancer who are likely to receive high-intensity EoL care. Health systems should consider incorporating these risk factors into decision-support tools to assist clinicians in identifying which patients should be referred to hospice and palliative care.
AB - Introduction: High-intensity end-of-life (EoL) care can be burdensome for patients, caregivers, and health systems and does not confer any meaningful clinical benefit. Yet, there are significant knowledge gaps regarding the predictors of high-intensity EoL care. In this study, we identify risk factors associated with high-intensity EoL care among older adults with the four most common malignancies, including breast, prostate, lung, and colorectal cancer. Materials and Methods: Using SEER-Medicare data, we conducted a retrospective analysis of Medicare beneficiaries aged 65 and older who died of breast, prostate, lung, or colorectal cancer between 2011 and 2015. We used multivariable logistic regression to identify clinical, demographic, socioeconomic, and geographic predictors of high-intensity EoL care, which we defined as death in an acute care hospital, receipt of any oral or parenteral chemotherapy within 14 days of death, one or more admissions to the intensive care unit within 30 days of death, two or more emergency department visits within 30 days of death, or two or more inpatient admissions within 30 days of death. Results: Among 59,355 decedents, factors associated with increased likelihood of receiving high-intensity EoL care were increased comorbidity burden (odds ratio [OR]:1.29; 95% confidence interval [CI]:1.28–1.30), female sex (OR:1.05; 95% CI:1.01–1.09), Black race (OR:1.14; 95% CI:1.07–1.23), Other race/ethnicity (OR:1.20; 95% CI:1.10–1.30), stage III disease (OR:1.11; 95% CI:1.05–1.18), living in a county with >1,000,000 people (OR:1.23; 95% CI:1.16–1.31), living in a census tract with 10%–<20% poverty (OR:1.09; 95% CI:1.03–1.16) or 20%–100% poverty (OR:1.12; 95% CI:1.04–1.19), and having state-subsidized Medicare premiums (OR:1.18; 95% CI:1.12–1.24). The risk of high-intensity EoL care was lower among patients who were older (OR:0.98; 95% CI:0.98–0.99), lived in the Midwest (OR:0.69; 95% CI:0.65–0.75), South (OR:0.70; 95% CI:0.65–0.74), or West (OR:0.81; 95% CI:0.77–0.86), lived in mostly rural areas (OR:0.92; 95% CI:0.86–1.00), and had poor performance status (OR:0.26; 95% CI:0.25–0.28). Results were largely consistent across cancer types. Discussion: The risk factors identified in our study can inform the development of new interventions for patients with cancer who are likely to receive high-intensity EoL care. Health systems should consider incorporating these risk factors into decision-support tools to assist clinicians in identifying which patients should be referred to hospice and palliative care.
KW - Breast cancer
KW - Gastrointestinal cancer
KW - Geriatric oncology
KW - Lung cancer
KW - Palliative care
KW - Prostate cancer
UR - http://www.scopus.com/inward/record.url?scp=85191324612&partnerID=8YFLogxK
U2 - 10.1016/j.jgo.2024.101774
DO - 10.1016/j.jgo.2024.101774
M3 - Article
C2 - 38676975
AN - SCOPUS:85191324612
SN - 1879-4068
VL - 15
JO - Journal of Geriatric Oncology
JF - Journal of Geriatric Oncology
IS - 5
M1 - 101774
ER -