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16-Year Trends in Aggressive End-of-Life Care in Patients With Lung Cancer

By: Celeste L. Dixon
Posted: Monday, January 21, 2019

Using the National Inpatient Sample, the largest publicly available, all-payer, U.S. inpatient database, investigators published a study of patients with metastatic lung cancer in the Journal of Oncology Practice. It showed that from 1998 to 2014, despite substantial increases in the utilization of palliative care, higher intensive care unit use during terminal hospitalizations resulted in rising overall costs generated by this population.

Aggressive end-of-life care “is a marker of poor-quality care,” asserted corresponding author Bobby Daly, MD, MBA, of Memorial Sloan Kettering Cancer Center, New York, and colleagues. Not only has it “not demonstrated a survival benefit, [but it] is associated with worse quality of life for patients and poorer bereavement adjustment for family members.”

A total of 412,946 patients were identified as having stage IV lung cancer and a terminal hospitalization. Over the 16 evaluated years, the proportion of patients admitted to the intensive care unit during their final hospitalization rose from 13.3% to 27.9% (P < .001).

“The mean total hospitalization charges rose from $29,386 in 1998 to $72,469 in 2014,” noted Dr. Daly and colleagues, although the mean length of hospital stay decreased by 15%. “Promisingly, palliative care encounters for terminal hospitalizations also increased during this period from 8.7% to 53.0% (P < .01)…. However, this did not offset the [intensive-care unit] trend.”

Evidence indicates that many oncology intensive care unit admissions are “potentially avoidable,” pointed out the researchers. To reduce costs and increase satisfaction of patients at the end of life and their caregivers, the team suggested that providers continue to increase the use of “innovative interventions, like patient-reported outcomes, hospital-in-the-home interventions, oncology medical homes, and lay navigators.”

Disclosure: The study authors’ disclosures can be found at ascopubs.org.



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