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. 2008 Jan;133(1):72-8.
doi: 10.1378/chest.07-1007. Epub 2007 Nov 7.

Trends in end-of-life ICU use among older adults with advanced lung cancer

Gulshan Sharma  1 , Jean Freeman, Dong Zhang, James S Goodwin
Affiliations

Trends in end-of-life ICU use among older adults with advanced lung cancer

Gulshan Sharma et al. Chest. 2008 Jan.

Abstract

Background: There is increasing concern about the appropriateness of intensive medical care near the end of life in ICUs throughout the United States. As a result of hospice expansion in the 1990s, we hypothesized that ICU use decreased over time in older adults with advanced lung cancer.

Methods: Retrospective analysis using the linked Surveillance, Epidemiology and End Results Medicare database. There were 45,627 Medicare beneficiaries > or = 66 years of age with confirmed stage IIIB or IV lung cancer between January 1, 1992, and December 31, 2002, who died within a year of their cancer diagnosis from 1993 through 2002.

Results: ICU use in the last 6 months of life increased from 17.5% in 1993 to 24.7% in 2002 (p < 0.001). After adjusting for patient characteristics, there was a 6.6% annual increase in ICU use from 1993 to 2002. During the same period, hospice use had risen from 28.8 to 49.9% (p < 0.001). A total of 6.2% of patients received both end-of-life ICU care and hospice care, a percentage that increased over time. The total health-care cost for Medicare fee-for-service patients during last 6 months was $40,929 for ICU users and $27,160 for non-ICU users (p < 0.001).

Conclusion: Despite increasing hospice use, ICU utilization among older adults dying with advanced lung cancer continued to rise in the United States during the 1990s.

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Conflict of interest statement

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Figures

Figure 1
Figure 1
Establishment of a study cohort of patients in whom stage IIIB or IV lung cancer was diagnosed from 1992 to 2002, and who died within 1 year of diagnosis between 1993 and 2002.
Figure 2
Figure 2
The clinical trajectory of patients admitted to an ICU with advanced lung cancer. The categories of re-hospitalized, hospice, and nursing home are not mutually exclusive.
Figure 3
Figure 3
Unadjusted percentages of ICU use and hospice use in the last 6 months of life among patients with advanced lung cancer by year of death. Cochran-Armitage trend test for ICU use from 1993 to 2002, p < 0.001; Cochran-Armitage trend test for hospice use from 1993 to 2002, p < 0.001.
See this image and copyright information in PMC

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