Use of Radiation Therapy in the Last 30 Days of Life Among a Large Population-Based Cohort of Elderly Patients in the United States
Use of Radiation Therapy in the Last 30 Days of Life Among a Large Population-Based Cohort of Elderly Patients in the United States
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DOI：
10.1200/jco.2012.45.0585
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发表时间：
2013-01-01
影响因子：
45.3
通讯作者：
Shih, Ya-Chen Tina
中科院分区：
文献类型：
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作者：
Guadagnolo, B. Ashleigh;Liao, Kai-Ping;Shih, Ya-Chen Tina
目的：我们的目标是评估癌症死亡者生命最后一个月内放射治疗(RT)的使用和相关费用。方法：我们使用监测、流行病学和最终结果(SEER)-Medicare链接数据库分析了2000-2007年间因肺癌、乳腺癌、前列腺癌、结直肠癌和胰腺癌死亡的202,299名患者的索赔数据。使用Logistic回归模型对人口、卫生服务和治疗相关变量对接受RT和接受超过10天RT的治疗的潜在影响进行调整分析。结果：在生命最后一个月接受放射治疗的15,287名患者(7.6%)中，其使用与种族、性别、收入和临终关怀等非临床因素相关。在这些患者中，2721人(17.8%)接受了超过10天的治疗。与在生命的最后30天内接受超过10天的RT的可能性更大相关的非临床因素包括：非西班牙裔白人，没有接受临终关怀，以及在独立的设施中接受治疗，而不是医院相关设施。在接受放射治疗的患者中，临终关怀与生命最后一个月的总护理成本降低32%有关。结论：尽管放射治疗的总体利用率很低，但在生命的最后30天接受放射治疗的患者中，近五分之一的患者接受治疗的天数超过10天。关于终末期癌症患者使用RT的医生决策需要更多的研究。J Clin Oncol31：80-87。(C)2012年美国临床肿瘤学会
Purpose:Our goal was to evaluate use and associated costs of radiation therapy (RT) in the last month of life among those dying of cancer.Methods:We used the Surveillance, Epidemiology, and End Results (SEER) -Medicare linked databases to analyze claims data for 202,299 patients dying as a result of lung, breast, prostate, colorectal, and pancreas cancers from 2000 to 2007. Logistic regression modeling was used to conduct adjusted analyses of potential impacts of demographic, health services, and treatment-related variables on receipt of RT and treatment with greater than 10 days of RT. Costs were calculated in 2009 dollars.Results:Among the 15,287 patients (7.6%) who received RT in the last month of life, its use was associated with nonclinical factors such as race, gender, income, and hospice care. Of these patients, 2,721 (17.8%) received more than 10 days of treatment. Nonclinical factors that were associated with greater likelihood of receiving more than 10 days of RT in the last 30 days of life included: non-Hispanic white race, no receipt of hospice care, and treatment in a freestanding, versus a hospital-associated facility. Hospice care was associated with 32% decrease in total costs of care in the last month of life among those receiving RT.Conclusion:Although utilization of RT overall was low, almost one in five of patients who received RT in their final 30 days of life spent more than 10 of those days receiving treatment. More research is needed into physician decision making regarding use of RT for patients with end-stage cancer. J Clin Oncol 31:80-87. (c) 2012 by American Society of Clinical Oncology