In a study reported in the Journal of Clinical Oncology, Panattoni et al found that patients dying from cancer located in Washington State who were insured by Medicaid were more likely to die at home without hospice services during the COVID-19 pandemic than those with commercial insurance.
Study Details
The study linked Washington state cancer registry records with claims from Medicaid and two commercial insurers for patients with solid tumors aged 18 to 64 years. They identified 322 Medicaid-insured and 162 commercially insured patients who died between March 2017 and June 2019 (pre–COVID-19 period) and 90 Medicaid-insured and 47 commercially insured patients who died between March and June 2020 (COVID-19 period). Place of death was categorized as hospital, hospice (home or nonhospital facility), and home without hospice.
Key Findings
For the COVID-19 period vs the pre–COVID-19 period, Medicaid-insured patients were significantly less likely to die in the hospital (32% vs 48%, P < .01) and significantly more likely to die at home without hospice (38% vs 20%, P < .01), with no significant change in proportions dying with hospice services (30% vs 32%, P = .88).
Among commercially insured patients, there were no significant differences between the COVID-19 vs pre–COVID-19 periods for death in the hospital (30% vs 36%, P =.61), at home without hospice (22% vs 22%, P = .75), or with hospice services (48% vs 42%, P = .46).
During the COVID-19 period, Medicaid-insured patients were significantly more likely vs commercially insured patients to die at home without hospice (38.0% vs 22.0%, P = .04) and numerically less likely to die with hospice services (30.0% vs 48%, P = .10).
During the COVID-19 period, male patients were more likely to die at home without hospice vs female patients (P ≤ .01), and patients with colorectal cancer were less likely than those with breast cancer (reference category) to die at home without hospice (P ≤ .001).
The investigators concluded, “The pandemic might have disproportionately worsened the end-of-life experience for Medicaid enrollees with cancer. Attention should be paid to societal and health system factors that decrease access to care for Medicaid patients.”
Scott D. Ramsey, MD, PhD, of the Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the Andy Hill Care Fund. For full disclosure of the study authors, visit ascopubs.org.
