Palliative care and end-of-life health care utilization in elderly patients with pancreatic cancer

Nizar Bhulani, Arjun Gupta, Ang Gao, Jenny Li, Chad Guenther, Chul Ahn, Elizabeth Paulk, Stephanie Houck, Muhammad S. Beg

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Palliative care has been associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients. Methods: Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room/intensive care unit (ICU) utilization and costs in the last 30 days of life were compared between both groups using propensity score-matched (PSM) analysis. Results: Of the 54,130 patients, 3,166 (5.8%) received palliative care and 70% received it in the last 30 days of life. The proportion of patients receiving palliative care increased from 1.4% in 2000 to 7.4% in 2009 (P<0.001). Patients with palliative care were more likely to be older, Asian and women. In the unmatched and PSM population, the average visits to the ER in the last 30 days of life were significantly higher for patients who received palliative care, and had a significantly higher cost of care. Similarly, ICU length of stay in the last 30 days of life was higher in patients who did not receive palliative care in both PSM and unmatched patients. Cost of care and number of ICU admissions were not different between palliative and non-palliative care groups in PSM and unmatched patients. Conclusions: In this study of Medicare patients with pancreatic cancer, palliative care use has increased between 2000 and 2009. Palliative care was largely offered close to the end of life and was not associated with reduced health care utilization or cost.

Original languageEnglish (US)
Pages (from-to)495-502
Number of pages8
JournalJournal of Gastrointestinal Oncology
Volume9
Issue number3
DOIs
StatePublished - Jun 1 2018

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Patient Acceptance of Health Care
Terminal Care
Pancreatic Neoplasms
Palliative Care
Propensity Score
Intensive Care Units
Medicare
Costs and Cost Analysis
Health Care Costs
Hospital Emergency Service
Length of Stay

Keywords

  • Cost of care
  • Emergency room
  • End-of-life
  • Intensive care unit (ICU)
  • Palliative care
  • Pancreatic cancer

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

Cite this

Palliative care and end-of-life health care utilization in elderly patients with pancreatic cancer. / Bhulani, Nizar; Gupta, Arjun; Gao, Ang; Li, Jenny; Guenther, Chad; Ahn, Chul; Paulk, Elizabeth; Houck, Stephanie; Beg, Muhammad S.

In: Journal of Gastrointestinal Oncology, Vol. 9, No. 3, 01.06.2018, p. 495-502.

Research output: Contribution to journalArticle

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abstract = "Background: Palliative care has been associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients. Methods: Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room/intensive care unit (ICU) utilization and costs in the last 30 days of life were compared between both groups using propensity score-matched (PSM) analysis. Results: Of the 54,130 patients, 3,166 (5.8{\%}) received palliative care and 70{\%} received it in the last 30 days of life. The proportion of patients receiving palliative care increased from 1.4{\%} in 2000 to 7.4{\%} in 2009 (P<0.001). Patients with palliative care were more likely to be older, Asian and women. In the unmatched and PSM population, the average visits to the ER in the last 30 days of life were significantly higher for patients who received palliative care, and had a significantly higher cost of care. Similarly, ICU length of stay in the last 30 days of life was higher in patients who did not receive palliative care in both PSM and unmatched patients. Cost of care and number of ICU admissions were not different between palliative and non-palliative care groups in PSM and unmatched patients. Conclusions: In this study of Medicare patients with pancreatic cancer, palliative care use has increased between 2000 and 2009. Palliative care was largely offered close to the end of life and was not associated with reduced health care utilization or cost.",
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AU - Bhulani, Nizar

AU - Gupta, Arjun

AU - Gao, Ang

AU - Li, Jenny

AU - Guenther, Chad

AU - Ahn, Chul

AU - Paulk, Elizabeth

AU - Houck, Stephanie

AU - Beg, Muhammad S.

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N2 - Background: Palliative care has been associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients. Methods: Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room/intensive care unit (ICU) utilization and costs in the last 30 days of life were compared between both groups using propensity score-matched (PSM) analysis. Results: Of the 54,130 patients, 3,166 (5.8%) received palliative care and 70% received it in the last 30 days of life. The proportion of patients receiving palliative care increased from 1.4% in 2000 to 7.4% in 2009 (P<0.001). Patients with palliative care were more likely to be older, Asian and women. In the unmatched and PSM population, the average visits to the ER in the last 30 days of life were significantly higher for patients who received palliative care, and had a significantly higher cost of care. Similarly, ICU length of stay in the last 30 days of life was higher in patients who did not receive palliative care in both PSM and unmatched patients. Cost of care and number of ICU admissions were not different between palliative and non-palliative care groups in PSM and unmatched patients. Conclusions: In this study of Medicare patients with pancreatic cancer, palliative care use has increased between 2000 and 2009. Palliative care was largely offered close to the end of life and was not associated with reduced health care utilization or cost.

AB - Background: Palliative care has been associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients. Methods: Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room/intensive care unit (ICU) utilization and costs in the last 30 days of life were compared between both groups using propensity score-matched (PSM) analysis. Results: Of the 54,130 patients, 3,166 (5.8%) received palliative care and 70% received it in the last 30 days of life. The proportion of patients receiving palliative care increased from 1.4% in 2000 to 7.4% in 2009 (P<0.001). Patients with palliative care were more likely to be older, Asian and women. In the unmatched and PSM population, the average visits to the ER in the last 30 days of life were significantly higher for patients who received palliative care, and had a significantly higher cost of care. Similarly, ICU length of stay in the last 30 days of life was higher in patients who did not receive palliative care in both PSM and unmatched patients. Cost of care and number of ICU admissions were not different between palliative and non-palliative care groups in PSM and unmatched patients. Conclusions: In this study of Medicare patients with pancreatic cancer, palliative care use has increased between 2000 and 2009. Palliative care was largely offered close to the end of life and was not associated with reduced health care utilization or cost.

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KW - Emergency room

KW - End-of-life

KW - Intensive care unit (ICU)

KW - Palliative care

KW - Pancreatic cancer

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