End-of-life care in Medicare beneficiaries dying with pancreatic cancer

Abstract

Background: The authors' goal was to characterize hospice enrollment and aggressiveness of care for pancreatic cancer patients at the end of life.

Methods: Surveillance, Epidemiology, and End Results and linked Medicare claims data (1992-2006) were used to identify patients with pancreatic cancer who had died (n = 22,818). The authors evaluated hospice use, hospice enrollment ≥ 4 weeks before death, and aggressiveness of care as measured by receipt of chemotherapy, acute care hospitalization, and intensive care unit (ICU) admission in the last month of life.

Results: Overall, 56.9% of patients enrolled in hospice, and 35.9% of hospice users enrolled for 4 weeks or more. Hospice use increased from 36.2% in 1992-1994 to 67.2% in 2004-2006 (P < .0001). Admission to the ICU and receipt of chemotherapy in the last month of life increased from 15.5% to 19.6% (P < .0001) and from 8.1% to 16.4% (P < .0001), respectively. Among patients with locoregional disease, those who underwent resection were less likely to enroll in hospice before death and much less likely to enroll early. They were also more likely to receive chemotherapy (14% vs 9%, P < .0001), be admitted to an acute care hospital (61% vs 53%, P < .0001), and be admitted to an ICU (27% vs 15%, P < .0001) in the last month of life.

Conclusions: Although hospice use increased over time, there was a simultaneous decrease in early enrollment and increase in aggressive care at the end of life for patients with pancreatic cancer.

Figure 1

Time trends in hospice use and early enrollment in hospice (≥4 weeks prior to death) among pancreatic cancer decedents, 1992–2006

Figure 2

Time trends in receipt of chemotherapy and admission to an intensive care unit or acute care hospital within the last month of life among pancreatic cancer decedents, 1992–2006