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Malone-Moses M, Zhang M, El-Mufti L, Russo R. Letter to the Editor: Performance of an Integrated Palliative Care Program for Beneficiaries Dually Eligible for Medicare and Medicaid: Member Experience Survey. J Palliat Med 2023; 26:1446-1447. [PMID: 37643303 DOI: 10.1089/jpm.2023.0418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Affiliation(s)
| | - Mary Zhang
- Commonwealth Care Alliance, Boston, Massachusetts, USA
| | | | - Rachel Russo
- Commonwealth Care Alliance, Boston, Massachusetts, USA
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Dzimitrowicz HE, Wilson LE, Jackson BE, Spees LP, Baggett CD, Greiner MA, Kaye DR, Zhang T, George D, Scales CD, Pritchard JE, Leapman MS, Gross CP, Dinan MA, Wheeler SB. End-of-Life Care for Patients With Metastatic Renal Cell Carcinoma in the Era of Oral Anticancer Therapy. JCO Oncol Pract 2023; 19:e213-e227. [PMID: 36413741 PMCID: PMC9970274 DOI: 10.1200/op.22.00401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/31/2022] [Accepted: 10/06/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE New therapies including oral anticancer agents (OAAs) have improved outcomes for patients with metastatic renal cell carcinoma (mRCC). However, little is known about the quality of end-of-life (EOL) care and systemic therapy use at EOL in patients receiving OAAs or with mRCC. METHODS We retrospectively analyzed EOL care for decedents with mRCC in two parallel cohorts: (1) patients (RCC diagnosed 2004-2015) from the University of North Carolina's Cancer Information and Population Health Resource (CIPHR) and (2) patients (diagnosed 2007-2015) from SEER-Medicare. We assessed hospice use in the last 30 days of life and existing measures of poor-quality EOL care: systemic therapy, hospital admission, intensive care unit admission, and > 1 ED visit in the last 30 days of life; hospice initiation in the last 3 days of life; and in-hospital death. Associations between OAA use, patient and provider characteristics, and EOL care were examined using multivariable logistic regression. RESULTS We identified 410 decedents in the CIPHR cohort (53.4% received OAA) and 1,508 in SEER-Medicare (43.5% received OAA). Prior OAA use was associated with increased systemic therapy in the last 30 days of life in both cohorts (CIPHR: 26.5% v 11.0%; P < .001; SEER-Medicare: 23.4% v 11.7%; P < .001), increased in-hospital death in CIPHR, and increased hospice in the last 30 days in SEER-Medicare. Older patients were less likely to receive systemic therapy or be admitted in the last 30 days or die in hospital. CONCLUSION Patients with mRCC who received OAAs and younger patients experienced more aggressive EOL care, suggesting opportunities to optimize high-quality EOL care in these groups.
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Affiliation(s)
| | - Lauren E. Wilson
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | | | - Lisa P. Spees
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC
| | - Christopher D. Baggett
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC
- Department of Epidemiology, Gillings School of Global Public Health, UNC-CH, Chapel Hill, NC
| | - Melissa A. Greiner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Deborah R. Kaye
- Department of Surgery (Urology), Duke University School of Medicine, Durham, NC
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC
| | - Tian Zhang
- Division of Hematology and Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
- Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC
| | - Daniel George
- Department of Medicine, Duke University School of Medicine, Durham, NC
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC
| | - Charles D. Scales
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
- Department of Surgery (Urology), Duke University School of Medicine, Durham, NC
| | - Jessica E. Pritchard
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Michael S. Leapman
- Department of Urology, Yale School of Medicine, New Haven, CT
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
| | - Cary P. Gross
- Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center, New Haven, CT
- Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Michaela A. Dinan
- Department of Medicine, Yale School of Medicine, New Haven, CT
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Stephanie B. Wheeler
- Lineberger Comprehensive Cancer Center, UNC-CH, Chapel Hill, NC
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC-CH), Chapel Hill, NC
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