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Hospice care, cancer-directed therapy, and Medicare expenditures among older patients dying with malignant brain tumors.
- Source :
-
Neuro-oncology [Neuro Oncol] 2018 Jun 18; Vol. 20 (7), pp. 986-993. - Publication Year :
- 2018
-
Abstract
- Background: End-of-life care for older adults with malignant brain tumors is poorly understood. The purpose of this study is to quantify end-of-life utilization of hospice care, cancer-directed therapy, and associated Medicare expenditures among older adults with malignant brain tumors.<br />Methods: This retrospective cohort study included deceased Medicare beneficiaries age ≥65 with primary malignant brain tumor (PMBT) or secondary MBT (SMBT) receiving care within a southeastern cancer community network including academic and community hospitals from 2012-2015. Utilization of hospice and cancer-directed therapy and total Medicare expenditures in the last 30 days of life were calculated using generalized linear and mixed effect models, respectively.<br />Results: Late (1-3 days prior to death) or no hospice care was received by 24% of PMBT (n = 383) and 32% of SMBT (n = 940) patients. SMBT patients received late hospice care more frequently than PMBT patients (10% vs 5%, P = 0.002). Cancer-directed therapy was administered to 18% of patients with PMBT versus 25% with SMBT (P = 0.003). Nonwhite race, male sex, and receipt of any hospital-based care in the final 30 days of life were associated with increased risk of late or no hospice care. The average decrease in Medicare expenditures associated with hospice utilization for patients with PMBT was $-12,138 (95% CI: $-18,065 to $-6210) and with SMBT was $-1,508 (95% CI: $-3,613 to $598).<br />Conclusions: Receiving late or no hospice care was common among older patients with malignant brain tumors and was significantly associated with increased total Medicare expenditures for patients with PMBT.
- Subjects :
- Aged
Combined Modality Therapy
Female
Follow-Up Studies
Hospitalization economics
Hospitalization statistics & numerical data
Humans
Male
Medicare economics
Outcome Assessment, Health Care
Prognosis
Retrospective Studies
Survival Rate
United States
Brain Neoplasms economics
Brain Neoplasms therapy
Health Expenditures statistics & numerical data
Hospice Care economics
Hospice Care statistics & numerical data
Medicare statistics & numerical data
Terminal Care economics
Subjects
Details
- Language :
- English
- ISSN :
- 1523-5866
- Volume :
- 20
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Neuro-oncology
- Publication Type :
- Academic Journal
- Accession number :
- 29156054
- Full Text :
- https://doi.org/10.1093/neuonc/nox220