The end-of-life care for women < 65 years old with metastatic breast cancer includes an increase in intensive care unit (ICU) admissions and more intense acute care in patients from non-White neighborhoods (JCO Oncol Pract. 2020. doi:10.1200/OP.20.00089)
“There is limited evidence on the intensity of end-of-life (EOL) care for women < 65 years old, who account for about 40% of breast cancer deaths in the United States,” explained Alessandry Ferrario, PhD, Harvard Medical School and Harvard Pilgrim Healthcare Institute (Boston, MA) and colleagues. “Using established indicators, we estimated the intensity of EOL care among these women.”
Women with metastatic breast cancer and with more than one hospital admission, emergency department visit, or an ICU visit, and/or used antineoplastic therapy within the last month of their lives were identified from 2000-2014 insurer claims data. The intensity of the EOL care was assessed using multivariate logistic regression.
An increase in EOL ICU admissions between 2000-2003 and 2010-2014 from 14% (95% CI, 10% to 17%) to 23% (95% CI, 20% to 26%) and a small increase in emergency department visits from 10% (95% CI, 7% to 13%) to 12% (95% CI, 9% to 15%), both statistically significant. No significant change in the number of women with more than one EOL hospitalization and those receiving antineoplastic therapy. The results showed that women from predominantly mixed, Hispanic, Black, or Asian neighborhoods experienced more intense care (odds ratio, 1.39; 95% CI, 1.10 to 1.77 for ICU).
“Consistent with findings in the Medicare population, our results suggest an overall increase in the number of ICU admissions at the EOL over time,” concluded Dr Ferrario and colleagues. “They also suggest that patients from non-White neighborhoods receive more intense acute care.”—Lisa Kuhns
