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Association between survival time with metastatic breast cancer and aggressive end-of-life care

  • Epidemiology
  • Published:
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Abstract

Purpose

For women with stage IV breast cancer (BC), the association between survival time (ST) and use of aggressive end-of-life (EOL) care is unknown.

Methods

We used the SEER-Medicare database to identify women with stage IV BC diagnosed 2002–2011 who died by 12/31/2012. Aggressive EOL care was defined as receipt in the last month of life: >1 ED visit, >1 hospitalization, ICU admission, life-extending procedures, hospice admission within 3 days of death, IV chemotherapy within 14 days of death, and/or ≥10 unique physician encounters in the last 6 months of life. Receipt of aggressive EOL care and hospice in the last month of life were determined using claims, and multivariable analysis was used to identify factors associated with receipt. Costs of care were also evaluated.

Results

We identified 4521 eligible patients. Of these, 2748 (60.8%) received aggressive EOL care. Factors associated with aggressive EOL care were race (OR 1.45, 95% CI 1.19–1.81 for blacks compared to whites) and more frequent oncology office visits (OR 1.56, 95% CI 1.28–1.90). Patients who lived >12 months after diagnosis were less likely to receive aggressive EOL care (OR 0.44, 95% CI 0.38–0.52), and more likely to utilize hospice (OR 1.43, 95% CI 1.21–1.69) compared to patients who lived ≤6 months. Patients with a shorter ST had significantly higher costs of care per-month-alive compared to patients with longer ST.

Conclusion

Patients with a shorter ST were more likely to receive aggressive EOL care and had higher costs of care compared to patients who lived longer.

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Acknowledgement

This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the National Cancer Institute; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database. Dr. Accordino is a recipient of Dr. Charles A. Coltman, Jr. Fellowship from the Hope Foundation. Dr. Hershman (NCI R01 CA186084) and Dr. Wright (NCI R01CA169121) are recipients of Grants from the National Cancer Institute. Dr. Hershman is a recipient of a Grant from The American Society of Clinical Oncology/Breast Cancer Research Foundation.

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Authors and Affiliations

  1. Department of Medicine, Columbia University College of Physicians and Surgeons, 161 Ft Washington Ave, Room 9-962, New York, NY, 10032, USA

    Melissa K. Accordino, Alfred I. Neugut & Dawn L. Hershman

  2. Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Melissa K. Accordino, Jason D. Wright, Alfred I. Neugut, Grace C. Hillyer & Dawn L. Hershman

  3. Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Jason D. Wright

  4. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA

    Sowmya Vasan, Alfred I. Neugut, Grace C. Hillyer & Dawn L. Hershman

  5. Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY, USA

    Tal Gross

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  1. Melissa K. Accordino
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Correspondence to Melissa K. Accordino.

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Accordino, M.K., Wright, J.D., Vasan, S. et al. Association between survival time with metastatic breast cancer and aggressive end-of-life care. Breast Cancer Res Treat 166, 549–558 (2017). https://doi.org/10.1007/s10549-017-4420-4

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  • DOI: https://doi.org/10.1007/s10549-017-4420-4

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