Cost of hospital-based end-of-life care high for elderly with brain tumors

Hospital-based end-of-life care for elderly patients with malignant brain tumors is associated with up to $16,000 in expenses, according to a research letter published in JAMA Oncology.

“These findings underscore the need for interventions that facilitate earlier communication about common illness trajectories and care preferences in the brain tumor population — specifically, discussions about how and where the patient would like to manage a foreseeable neurologic decline,” Laura L. Dover, MD, from the department of radiation oncology at University of Alabama at Birmingham, and colleagues wrote.

The patterns of end-of-life care for elderly patients with primary or secondary malignant brain tumors are unknown, but can be aggressive and costly.

Dover and colleagues used Medicare claims data between January 2012 and December 2015 to evaluate hospital-based care and costs in the last 30 days of life among patients aged 65 years or older with malignant tumors. Researchers aimed to identify risk factors for aggressive care and measure the association between aggressive care and costs.

The analysis included 1,323 decedents with primary (n = 383) or secondary (n = 940) malignant brain tumors. Researchers compared total costs to Medicare and hospital-based care within 30 days of death in the two groups.

The researchers used generalized log-linear models to assess risk for hospital-based care and linear mixed-effects models to measure costs.

During the last 30 days of life, patients with secondary tumors had a greater likelihood of an ED visit (50% vs. 40%; P < .001) or hospitalization (50% vs. 42%; P = .009) than patients with primary tumors. However, researchers observed no difference in ICU admissions.

The total costs to Medicare appeared comparable between the groups at $8,592 for primary tumors and $9,964 for secondary tumors.

More than half of patients (54.8%; n = 725) used hospital-based care. Younger men with secondary tumors appeared more likely to receive hospital-based care.

“Certain sociodemographic characteristics, such as being male, are consistent risk factors for aggressive end-of-life care, which may represent different preferences as opposed to inequities in care,” the researchers wrote.

Among those with primary tumors, likelihood of hospital-based care increased among men (RR = 1.28; 95% CI, 1.03-1.6) and those with a Charlson comorbidity score of 1 or higher (RR = 1.52; 95% CI, 1.11-2.06).

Among those with secondary tumors, risk factors for hospital-based care included a Charlson score of 1 or higher (RR = 1.81; 95% CI, 1.47-2.22) and increased age (RR = 0.92; 95% CI, 0.86-0.99).

Hospital-based care increased costs in patients with primary ($16,303) and secondary tumors ($13,132; P< .001 for both).

Researchers attributed overall high rates of care and costs to unprepared or unexperienced caretakers for the management of end-of-life symptoms. – by Melinda Stevens

Disclosure: Dover reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.