Abstract
Introduction: Advanced imaging can inform prognosis and may be a mechanism to de-escalate unnecessary end-of-life care in patients with cancer. Associations between greater use of advanced imaging and less-aggressive end-of-life care in real-world practice has not been examined. Methods: We conducted a retrospective analysis of SEER-Medicare data on patients who died from breast, lung, colorectal, or prostate cancer between 2002 and 2007. Hospital referral region (HRR)-level use of computerized tomography (CT), magnetic resonance imaging, and positron emission tomography was categorized by tertile of imaging use and correlated with hospice enrollment overall and late hospice enrollment using multivariable logistic regression. Results: A total of 55,058 patients met study criteria. Hospice use ranged from 50.8% (colorectal cancer) to 62.1% (prostate cancer). In multivariable analyses, hospital referral regions (HRRs) with high rates of CT imaging were associated with lower odds of hospice enrollment (odds ratio, 0.80; 95% CI, 0.70–0.90) and late enrollment among those who did enroll (odds ratio, 1.49; 95% CI, 1.26–1.76). HRRs with the highest rates of CT use were predominantly located in the Midwest and Northeast and associated with higher percentage population of black patients (14.5 vs 5.6%), greater comorbidity (28.4 vs 23.7%), metropolitan residence (93.9 vs 78.5%), and less than high school education (26.4 vs 19.3%). Conclusion: In this population-based retrospective study, we did not observe evidence that overall and timely hospice are associated with higher rates of imaging near the end of life. An observed association between higher rates of imaging, particularly CT, may be explained in part by HRR-level differences in practice patterns and patient demographic characteristics. Further research is warranted to explore the ability of oncologic imaging to appropriately de-escalate care.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 3619-3625 |
| Number of pages | 7 |
| Journal | Supportive Care in Cancer |
| Volume | 26 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 1 2018 |
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All Science Journal Classification (ASJC) codes
- Oncology
Keywords
- Breast neoplasms
- Colorectal neoplasms
- Diagnostic imaging
- Hospice care
- Lung neoplasms
- Outcome assessment (health care)
- Prostatic neoplasms
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Advanced imaging and hospice use in end-of-life cancer care. / Dinan, Michaela A.; Curtis, Lesley H.; Setoguchi Iwata, Soko; Cheung, Winson Y.
In: Supportive Care in Cancer, Vol. 26, No. 10, 01.10.2018, p. 3619-3625.Research output: Contribution to journal › Article
TY - JOUR
T1 - Advanced imaging and hospice use in end-of-life cancer care
AU - Dinan, Michaela A.
AU - Curtis, Lesley H.
AU - Setoguchi Iwata, Soko
AU - Cheung, Winson Y.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Introduction: Advanced imaging can inform prognosis and may be a mechanism to de-escalate unnecessary end-of-life care in patients with cancer. Associations between greater use of advanced imaging and less-aggressive end-of-life care in real-world practice has not been examined. Methods: We conducted a retrospective analysis of SEER-Medicare data on patients who died from breast, lung, colorectal, or prostate cancer between 2002 and 2007. Hospital referral region (HRR)-level use of computerized tomography (CT), magnetic resonance imaging, and positron emission tomography was categorized by tertile of imaging use and correlated with hospice enrollment overall and late hospice enrollment using multivariable logistic regression. Results: A total of 55,058 patients met study criteria. Hospice use ranged from 50.8% (colorectal cancer) to 62.1% (prostate cancer). In multivariable analyses, hospital referral regions (HRRs) with high rates of CT imaging were associated with lower odds of hospice enrollment (odds ratio, 0.80; 95% CI, 0.70–0.90) and late enrollment among those who did enroll (odds ratio, 1.49; 95% CI, 1.26–1.76). HRRs with the highest rates of CT use were predominantly located in the Midwest and Northeast and associated with higher percentage population of black patients (14.5 vs 5.6%), greater comorbidity (28.4 vs 23.7%), metropolitan residence (93.9 vs 78.5%), and less than high school education (26.4 vs 19.3%). Conclusion: In this population-based retrospective study, we did not observe evidence that overall and timely hospice are associated with higher rates of imaging near the end of life. An observed association between higher rates of imaging, particularly CT, may be explained in part by HRR-level differences in practice patterns and patient demographic characteristics. Further research is warranted to explore the ability of oncologic imaging to appropriately de-escalate care.
AB - Introduction: Advanced imaging can inform prognosis and may be a mechanism to de-escalate unnecessary end-of-life care in patients with cancer. Associations between greater use of advanced imaging and less-aggressive end-of-life care in real-world practice has not been examined. Methods: We conducted a retrospective analysis of SEER-Medicare data on patients who died from breast, lung, colorectal, or prostate cancer between 2002 and 2007. Hospital referral region (HRR)-level use of computerized tomography (CT), magnetic resonance imaging, and positron emission tomography was categorized by tertile of imaging use and correlated with hospice enrollment overall and late hospice enrollment using multivariable logistic regression. Results: A total of 55,058 patients met study criteria. Hospice use ranged from 50.8% (colorectal cancer) to 62.1% (prostate cancer). In multivariable analyses, hospital referral regions (HRRs) with high rates of CT imaging were associated with lower odds of hospice enrollment (odds ratio, 0.80; 95% CI, 0.70–0.90) and late enrollment among those who did enroll (odds ratio, 1.49; 95% CI, 1.26–1.76). HRRs with the highest rates of CT use were predominantly located in the Midwest and Northeast and associated with higher percentage population of black patients (14.5 vs 5.6%), greater comorbidity (28.4 vs 23.7%), metropolitan residence (93.9 vs 78.5%), and less than high school education (26.4 vs 19.3%). Conclusion: In this population-based retrospective study, we did not observe evidence that overall and timely hospice are associated with higher rates of imaging near the end of life. An observed association between higher rates of imaging, particularly CT, may be explained in part by HRR-level differences in practice patterns and patient demographic characteristics. Further research is warranted to explore the ability of oncologic imaging to appropriately de-escalate care.
KW - Breast neoplasms
KW - Colorectal neoplasms
KW - Diagnostic imaging
KW - Hospice care
KW - Lung neoplasms
KW - Outcome assessment (health care)
KW - Prostatic neoplasms
UR - http://www.scopus.com/inward/record.url?scp=85046439169&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85046439169&partnerID=8YFLogxK
U2 - 10.1007/s00520-018-4223-0
DO - 10.1007/s00520-018-4223-0
M3 - Article
C2 - 29728843
AN - SCOPUS:85046439169
VL - 26
SP - 3619
EP - 3625
JO - Supportive Care in Cancer
JF - Supportive Care in Cancer
SN - 0941-4355
IS - 10
ER -