Predictors of high-intensity care at the end of life among older adults with solid tumors: A population-based study

• Published in: Journal of geriatric oncology 2024-06, Vol.15 (5), p.101774, Article 101774
• Main Authors: Baird, Courtney E., Wulff-Burchfield, Elizabeth, Egan, Pamela C., Hugar, Lee A., Vyas, Ami, Trikalinos, Nikolaos A., Liu, Michael A., Bélanger, Emmanuelle, Olszewski, Adam J., Bantis, Leonidas E., Panagiotou, Orestis A.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Breast cancer; Breast Neoplasms - epidemiology; Breast Neoplasms - mortality; Breast Neoplasms - therapy; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - mortality; Colorectal Neoplasms - therapy; Female; Gastrointestinal cancer; Geriatric oncology; Hospitalization - statistics & numerical data; Humans; Logistic Models; Lung cancer; Lung Neoplasms - epidemiology; Lung Neoplasms - mortality; Lung Neoplasms - therapy; Male; Medicare - statistics & numerical data; Neoplasms - epidemiology; Neoplasms - mortality; Neoplasms - therapy; Palliative care; Prostate cancer; Prostatic Neoplasms - epidemiology; Prostatic Neoplasms - mortality; Prostatic Neoplasms - therapy; Retrospective Studies; Risk Factors; SEER Program; Terminal Care - statistics & numerical data; United States - epidemiology
• ISSN: 1879-4068; 1879-4076; 1879-4076
• DOI: 10.1016/j.jgo.2024.101774

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. 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. 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%–