In a study reported in JCO Oncology Practice, Ferrario et al found a sizable increase in end-of-life intensive care unit (ICU) admissions and a small but significant increase in emergency department visits over time among commercially insured women younger than age 65 with metastatic breast cancer in the United States.
As stated by the investigators, “There is limited evidence on the intensity of end-of-life care for women [younger than] 65 years old, who account for about 40% of breast cancer deaths in the United States.”
“Consistent with findings in the Medicare population, our results suggest an overall increase in the number of ICU admissions at the end-of-life over time. They also suggest that patients from non-White neighborhoods receive more intense acute care.”— Ferrario et al
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Study Details
The study used 2000–2014 claims data from a large U.S. insurer (through Optum’s de-identified Clinformatics Data Mart Database) to find 2,126 women who died with metastatic breast cancer between November 2000 and December 2014 who were younger than age 64 at diagnosis. Overall, 89% of women were older than 40 at diagnosis; 64% resided in predominantly non-Hispanic White neighborhoods (64%); and 47% lived in the South and 30% in the Midwest.
Outcomes analyzed were more than one hospital admission, more than one emergency department visit, or any ICU admission within the last 30 days of life, and receipt of antineoplastic therapy within the last 14 days of life.
Key Findings
Proportions of women having more than one end-of-life hospitalization were 11% in 2000–2003 vs 14% in 2020–2014, with no significant annual increase (P = .086). Proportions of women with more than one end-of-life emergency department visit were 10% in 2000–2003 vs 12% in 2010–2014 (P = .018 for annual increase).
Proportions of women with an end-of-life ICU admission were 14% in 2000–2003 vs 23% in 2010–2014 (P < .01 for annual increase). Proportions of women who received antineoplastic treatment within the last 14 days of life were 23% in 2000–2003 vs 24% in 2010–2014 (P = .56 for annual increase).
Women living in predominantly mixed, Hispanic, Black, or Asian neighborhoods were more likely to have end-of-life hospital admission (odds ratio [OR] = 1.38, P = .03) and ICU admission (OR = 1.39, P = .01). Those living in more deprived neighborhoods (based on Area Deprivation Index) were less likely to receive end-of-life antineoplastic treatment (OR = 0.71, P <.01). Those living in the South were less likely to have end-of-life emergency department visits vs those living in the Midwest (OR = 0.70, P = .04).
The investigators concluded: “Consistent with findings in the Medicare population, our results suggest an overall increase in the number of ICU admissions at the end-of-life over time. They also suggest that patients from non-White neighborhoods receive more intense acute care.”
Alessandra Ferrario, PhD, of the Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, is the corresponding author for the JCO Oncology Practice article.
Disclosure: The study was supported by the Harvard Medical School Department of Population Medicine’s Ebert Award and grants from the National Cancer Institute. For full disclosures of the study authors, visit ascopubs.org.
