Trends in End-of-Life Care Quality Among Patients With Cancer, 2003 to 2019

Area of Science:

• Geriatric Oncology
• Palliative Care
• Health Services Research

Background:

• Ensuring high-quality end-of-life (EOL) care is vital for older adults with cancer, a leading cause of death in this demographic.
• Previous research on EOL care disparities in cancer patients has been limited, often focusing on specific racial/ethnic groups or single cancer types.

Purpose of the Study:

• To describe end-of-life (EOL) care practices among cancer decedents across diverse social and clinical characteristics using a population-based sample.
• To identify variations in EOL care utilization based on demographic factors and insurance status.

Main Methods:

• Retrospective cohort study utilizing linked cancer registry and administrative claims data from North Carolina (2003-2019).
• Examined five key EOL practices within 30 days of death: >1 emergency department (ED) visit, intensive care unit (ICU) admission, hospital admission, intravenous (IV) chemotherapy, and no hospice use.
• Assessed in-hospital death and late hospice initiation (within 3 days of death), analyzing descriptive differences by demographic characteristics.

Main Results:

• The study analyzed 150,412 cancer decedents, with 48% female and 23% non-Hispanic Black; 61% were Medicare beneficiaries.
• Hospital admission was the most frequent EOL practice (54%). While rates of no hospice use, ICU admission, hospital admissions, and in-hospital deaths decreased over time, they remained high in 2019 (52% and 38% respectively).
• Medicaid decedents exhibited better EOL care quality compared to other insurance groups, with lower rates of ED visits (9%), hospital admissions (45%), and higher rates of hospice initiation in the last 3 days (6%).

Conclusions:

• Significant variations in end-of-life (EOL) care practices exist among cancer decedents, necessitating further research into underlying causes.
• Interventions, such as EOL patient navigation programs, show potential for improving the quality of EOL care for cancer patients.