Explore End-Of-Life care among cancer patients with Alzheimer’s Disease and Related Dementias
Background: End-of-Life (EOL) care aims to reduce pain and limit aggressive intervention for those individuals with terminal illness through the period before death. It is particularly crucial for older persons with cancer. Aggressive EOL care is associated with sub-optimal quality of life for patients and increased expenditures for healthcare payers. In recent years, the incidence of Alzheimer’s Disease and Related Dementias (ADRD) among older persons with cancer has been rising. In addition, having ADRD gradually compromises their physical and mental status, communication skills, and cognitive functions. As the result of having ADRD, arranging EOL care for older persons with both conditions could become extremely challenging and costly. However, little is known about the aggressive EOL care patterns as well as expenditures on EOL care in older persons with both cancer and ADRD. Thus, this dissertation explored the EOL care patterns and estimated the Medicare expenditures of the EOL care in this patient group. Method: This dissertation consisted of two retrospective cohort studies using the 2004 to 2016 Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) data. The case cohort was beneficiaries with both cancer and ADRD, the control cohort was beneficiaries with cancer. A one-to-one Greedy Nearest Neighbor propensity score matching method was used to create the balanced non-ADRD group for the statistical analyses. Included beneficiaries were diagnosed with cancer (breast-female only, lung, colorectal, or prostate) and died between January 1st, 2005, and December 31st, 2016. They needed to continuously enroll in traditional Medicare for their last twelve months of life. For calculating EOL care spending, beneficiaries were also required to survive at least twelve months. The first study aimed to assess the quality of EOL care via established claim-based aggressive EOL care indicators. Multivariable logistic regression models were deployed to estimate the odds of receiving any aggressive EOL care. The second study estimated beneficiaries’ Medicare expenditure on EOL care. Generalized Estimating Equation Model was deployed to estimate the monthly Medicare expenditure for the last twelve months of life and Generalized Linear Models were constructed to assess the total EOL care expenditure. Results: Having ADRD attenuated older persons with cancer’s odds of utilizing any aggressive EOL care (AOR: 0.87, 95% CI: 0.85, 0.89) but resulted in consuming slightly more Medicare expenditures during EOL ($64,962.2 vs. $63,966.0, p=0.02) compared to those without ADRD. Also, over 50% of both beneficiary groups had aggressive EOL care utilization history. Higher odds of receiving aggressive EOL care were associated with beneficiaries who were minorities, had shorter overall survival, and had more comorbidity conditions. As for total Medicare spending, beneficiaries with ADRD had around 4% more in their last twelve months of life than those without ADRD. Specifically, Medicare spent more on inpatient services (7%), skilled nursing facility (130%), home health (44%), and hospice (26%) for beneficiaries with cancer and ADRD versus those without ADRD. Conclusion: Beneficiaries with both cancer and ADRD were unlikely to utilize aggressive EOL care; however, the prevalence difference of aggressive EOL care between study groups was not hugely wide. Beneficiaries with both cancer and ADRD tended to spend significantly more healthcare resources during the last twelve months of life, also certain types of care paid by Medicare had much higher spending on those individuals. Sensitivity analyses also underscored the potential effects of severity of ADRD on influencing the EOL care patterns and Medicare expenditures. This study provided recent characterizations of EOL care patterns as well as the estimations of EOL care cost for healthcare systems and providers to reference. Future health behavior intervention studies/EOL care programs are needed to alleviate the risks of utilizing aggressive EOL care and reduce its financial burden.
|Work Title||Explore End-Of-Life care among cancer patients with Alzheimer’s Disease and Related Dementias|
|License||In Copyright (Rights Reserved)|
|Publication Date||April 11, 2022|
|Deposited||April 11, 2022|
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