42: Understanding End-of-Life Cancer Care in Canada: an Updated 12-Year Retrospective Analysis of Three Provinces’ Administrative Health Care Data

2021 ◽  
Vol 163 ◽  
pp. S20-S21
Author(s):  
Amanda Khan ◽  
Hsien Seow ◽  
Rinku Sutradhar ◽  
Stuart Peacock ◽  
Kelvin Chan ◽  
...  
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Retrospective Analysis ◽  
Cancer Care ◽  
Health Care Data

scholarly journals Quality of end-of-life cancer care in Canada: a retrospective four-province study using administrative health care data

2015 ◽  
Vol 22 (5) ◽  
pp. 341 ◽  
Author(s):  
L. Barbera ◽  
H. Seow ◽  
R. Sutradhar ◽  
A. Chu ◽  
F. Burge ◽  
...  
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Cancer Care ◽  
Health Care Data

Patterns and costs of hospital-based cancer care in the last year of life: A national data linkage study in England.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18769-e18769
Author(s):  
Xhyljeta Luta ◽  
Katharina Diernberger ◽  
Joanna Bowden ◽  
Joanne Droney ◽  
Peter S Hall ◽  
...  
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Cancer Care ◽  
Hospital Admissions ◽  
Health Care Utilisation ◽  
Cost Of Care ◽  
Hospital Episode Statistics ◽  
Hospital Episode ◽  
Care Utilisation

e18769 Background: Delivery of high quality cancer care is associated with rising costs, both in earlier stages of the illness trajectory and at the end of life. A significant portion of the costs and health care utilisation occurs in the last year of life. Most publications to date have focused on costs in hospital. Little is known about the costs of care for cancer patients across the entire health service. The aim was to examine primary, secondary and acute health care utilisation and cost in the last 12 months of life and how these differ by cancer diagnosis and other patient characteristics among decedent patients aged 60 and over. Methods: We conducted a retrospective cohort study of people aged 60 years and over (N=26,077) who died in England between 2010 and 2017. We used routinely collected and linked data from primary care (Clinical Practice Research Datalink (CPRD) secondary and acute care, (Hospital Episode Statistics (HES), and death data (Office for National Statistics (ONS)). This provided a nationally representative sample of the English population. We analysed of healthcare utilisation and resource use amongst decedents by gender, primary cause of death, age, geography, socio-economic status and comorbidities. Results: Overall, 90.2 % of the cancer decedents were admitted in the hospital at least once in the last 12 months of life. About 50% of patients we admitted to hospital in the last month of life with 37.6 being admitted to the hospital more than once in the last month of life. The health care utilisation and costs increased sharply in the last month of life. life. The mean number of hospital admissions in the last year of life was 3.7 (SD, 5.8). Those dying of haematological cancers (N=2093) had highest number of hospital admissions (mean:7.2, SD:10.8) and longer average hospital stay (mean:36.7, SD:33.0) (mean:12.0, SD:14.4). Use of outpatient services was highest in the group dying of haematological cancers (mean:12.0, SD:14.4) whereas those dying of prostate cancer (N= 2197) had higher number of emergency (mean:2.0, SD: 1.9) and GP visits (mean:30.8, SD: 20.7). Healthcare costs were highest among haematological cancers and lowest among those dying of breast cancer. Proximity to death and comorbidities were the main contributors of end-of-life care health care utilisation and costs. Conclusions: This study uses large linked datasets (linked to the whole spectrum of hospital episode statistics) providing a comprehensive picture of healthcare services accessed by cancer patients at end of life in England. There is significant variation in use and cost of care for cancer patients in the last year and month of life. Further analysis of variation according to hospice, palliative, and social care service provision may identify strategies to address this variation.

scholarly journals Perspectives of Health Care Payer Organizations on Cancer Care Delivery Redesign: A National Study

2019 ◽  
Vol 15 (1) ◽  
pp. e46-e55 ◽  
Author(s):  
Manali I. Patel ◽  
David Moore ◽  
Jay Bhattacharya ◽  
Arnold Milstein ◽  
Tumaini R. Coker
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Cancer Care ◽  
Care Delivery ◽  
Comparative Method ◽  
The United States ◽  
National Study ◽  
Care Services ◽  
Care Payer ◽  
Logistic Support

INTRODUCTION: Despite advancements in cancer care, persistent gaps remain in the delivery of high-value end-of-life cancer care. The aim of this study was to examine views of health care payer organization stakeholders on approaches to the redesign of end-of-life cancer care delivery strategies to improve care. METHODS: We conducted semistructured interviews with 34 key stakeholders (eg, chief medical officers, medical directors) in 12 health plans and 22 medical group organizations across the United States. We recorded, transcribed, and analyzed interviews using the constant comparative method of qualitative analysis. RESULTS: Participants endorsed strategies to redesign end-of-life cancer care delivery to improve end-of-life care. Participants supported the use of nonprofessionals to deliver some cancer services through alternative formats (eg, telephone, Internet) and delivery of services in nonclinical settings. Participants reported that using nonprofessional providers to offer some services, such as goals of care discussions and symptom assessments, via telephone in community-based settings or in patients’ homes, may be more effective and efficient ways to deliver high-value cancer care services. Participants described challenges to redesign, including coordination with and acceptance by oncology providers and payment models required to financially support clinical changes. Some participants suggested solutions, including providing funding and logistic support to encourage implementation of care delivery innovations and to financially reward practices for delivery of high-value end-of-life cancer care services. CONCLUSION: Stakeholders from payer organizations endorsed opportunities to redesign cancer care delivery, and some are willing to provide logistic, design, and financial support to practices interested in improving end-of-life cancer care.

Resource use and costs in the last year of life among Medicare beneficiaries who died from prostate cancer versus with the disease between 2000 and 2007.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6631-6631
Author(s):  
Shelby D. Reed ◽  
Michaela A Dinan ◽  
Yanhong Li ◽  
Yinghong Zhang ◽  
Lesley H Curtis ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Health Care ◽  
End Of Life ◽  
Health Care Costs ◽  
Resource Use ◽  
Cancer Care ◽  
Inpatient Care ◽  
Hospice Care ◽  
The United States ◽  
Care Costs

6631 Background: Prostate cancer is one of the leading sources of overall cancer care costs among men in the United States. Medical resource use and costs associated with prostate cancer care at the end of life, remain poorly understood. Methods: Retrospective analysis of Surveillance, Epidemiology, and End Results (SEER) -Medicare data was used to characterize changes in resource utilization and health care costs to the Centers for Medicare and Medicaid (CMS) in patients diagnosed with prostate cancer who died of prostate cancer vs. non-prostate causes between 2000 and 2007. Results: A total of 34,727 patients with prostate cancer met study criteria. Patients who died of prostate cancer were significantly more likely to have been diagnosed with incident distant metastatic disease (27% vs. 4%) and had fewer comorbid conditions than patients who died of other causes. In the year prior to death, men who died of prostate cancer had lower mean inpatient costs ($20,769 vs. $29,851), resulting from fewer hospitalizations (1.8 vs. 2.1) and fewer days spent in the hospital (12.2 vs. 15.7) and the ICU (1.4 vs. 3.4) as compared to men who were diagnosed with prostate cancer but died of some other cause (all P< 0.001). Men who died of prostate cancer also had lower rates of SNF utilization (32.8% vs 36.2%) and spent fewer days in SNF institutions (11.7 vs 14.7) (both P< 0.001). Conversely, men who died of prostate cancer were more likely to have enrolled in hospice (62% vs. 28%) with higher mean hospice costs ($5,117 vs. $1,981) (both P< 0.001). The substitution of more hospice care relative to inpatient care for men who died of prostate cancer resulted in lower total health care costs ($42,572 vs. $45,830; P< 0.001) relative to men who died from non-prostate cancer causes. Conclusions: Among men with a diagnosis of prostate cancer who died between 2000 and 2007, those with prostate cancer-specific mortality had lower overall health care costs than those who died from other causes. Less aggressive inpatient care near the end of life may explain the differences in cost. Ongoing investigation of care at the end of life is warranted given recent changes in the treatment landscape of metastatic prostate cancer.

scholarly journals System-Level Health-Care Integration and the Costs of Cancer Care Across the Disease Continuum

2018 ◽  
Vol 14 (3) ◽  
pp. e149-e157 ◽  
Author(s):  
Deborah R. Kaye ◽  
Hye Sung Min ◽  
Edward C. Norton ◽  
Zaojun Ye ◽  
Jonathan Li ◽  
...  
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Cancer Care ◽  
Survival Rates ◽  
System Level ◽  
Policy Reforms ◽  
Medicare Data ◽  
Care Integration ◽  
Study Interval ◽  
Integrated Delivery

Purpose: Policy reforms in the Affordable Care Act encourage health care integration to improve quality and lower costs. We examined the association between system-level integration and longitudinal costs of cancer care. Methods: We used linked SEER-Medicare data to identify patients age 66 to 99 years diagnosed with prostate, bladder, esophageal, pancreatic, lung, liver, kidney, colorectal, breast, or ovarian cancer from 2007 to 2012. We attributed each patient to one or more phases of care (ie, initial, continuing, and end of life) according to time from diagnosis until death or end of study interval. For each phase, we aggregated all claims with the primary cancer diagnosis and identified patients treated in an integrated delivery network (IDN), as defined by the Becker Hospital Review list of the top 100 most integrated health delivery systems. We then determined if care provided in an IDN was associated with decreased payments across cancers and for each individual cancer by phase and across phases. Results: We identified 428,300 patients diagnosed with one of 10 common cancers. Overall, there were no differences in phase-based payments between IDNs and non-IDNs. Average adjusted annual payments by phase for IDN versus non-IDNs were as follows: initial, $14,194 versus $14,421, respectively ( P = .672); continuing, $2,051 versus $2,099 ( P = .566); and end of life, $16,257 versus $16,232 ( P = .948). However, in select cancers, we observed lower payments in IDNs. For bladder cancer, payments at the end of life were lower for IDNs ($11,041 v $12,331; P = .008). Of the four cancers with the lowest 5-year survival rates (ie, pancreatic, lung, esophageal, and liver), average expenditures during the initial and continuing-care phases were lower for patients with liver cancer treated in IDNs. Conclusion: For patients with one of 10 common malignancies, treatment in an IDN generally is not associated with lower costs during any phase of cancer care.

Telemedicine in Cancer Care

2018 ◽  
pp. 540-545 ◽  
Author(s):  
S. Joseph Sirintrapun ◽  
Ana Maria Lopez
Keyword(s):  
Health Care ◽  
Access To Care ◽  
Cancer Care ◽  
Symptom Management ◽  
Lifestyle Modification ◽  
Clinical Settings ◽  
Home Based ◽  
Home Based Care ◽  
Care Costs ◽  
Improve Access

Telemedicine uses telecommunications technology as a tool to deliver health care to populations with limited access to care. Telemedicine has been tested in multiple clinical settings, demonstrating at least equivalency to in-person care and high levels of patient and health professional satisfaction. Teleoncology has been demonstrated to improve access to care and decrease health care costs. Teleconsultations may take place in a synchronous, asynchronous, or blended format. Examples of successful teleoncology applications include cancer telegenetics, bundling of cancer-related teleapplications, remote chemotherapy supervision, symptom management, survivorship care, palliative care, and approaches to increase access to cancer clinical trials. Telepathology is critical to cancer care and may be accomplished synchronously and asynchronously for both cytology and tissue diagnoses. Mobile applications support symptom management, lifestyle modification, and medication adherence as a tool for home-based care. Telemedicine can support the oncologist with access to interactive tele-education. Teleoncology practice should maintain in-person professional standards, including documentation integrated into the patient’s electronic health record. Telemedicine training is essential to facilitate rapport, maximize engagement, and conduct an accurate virtual exam. With the appropriate attachments, the only limitation to the virtual exam is palpation. The national telehealth resource centers can provide interested clinicians with the latest information on telemedicine reimbursement, parity, and practice. To experience the gains of teleoncology, appropriate training, education, as well as paying close attention to gaps, such as those inherent in the digital divide, are essential.

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