Background As cancer remains a leading cause of death for older adults, ensuring high-quality end-of-life (EOL) care is a critical component of cancer care. Prior studies have predominantly assessed EOL care for racial and ethnic disparities or among one cancer type. Therefore, using a population-based sample, our objective was to describe EOL care among decedents with cancer across various social and clinical characteristics. Methods This retrospective cohort study used 2003-2019 data from The University of North Carolina at Chapel Hill Cancer Information and Population Health Resource, which links cancer registry to administrative claims data in North Carolina. We examined five EOL practices within the last 30 days of life including: >1 emergency department (ED) visit, intensive care unit (ICU) admission, hospital admission, intravenous (IV) chemotherapy, and no hospice use. We assessed in-hospital death and late hospice initiation in the last 3 days of life. We descriptively assessed differences in EOL by various demographic characteristics. Results Among 150 412 decedents, 48% were female, 23% were non-Hispanic Black, and 61% were Medicare beneficiaries. The most frequent EOL care practice was hospital admission (54%). Over time, no hospice use, ICU admission, hospital admissions, and in-hospital deaths decreased. However, in 2019, hospital admissions and no hospice use were still high (52% & 38%, respectively). Compared to patients with other insurance, Medicaid decedents had the best quality EOL care: ED visit (9%), hospital admission (45%), and hospice initiation in the last 3 days (6%). Conclusions Additional research is needed to understand what could be driving these observed differences. Interventions, such as EOL patient navigation, could improve upon EOL care in patients with cancer.
Caston et al. (Sat,) studied this question.