Hospice or Hospital: The Costs of Dying of Cancer in the Oncology Care Model

Background: End-of-life management is a difficult aspect of cancer care. With the oncology care model (OCM), we have data to assess both clinical outcomes and total cost of care (TCOC). Objective: To measure and characterize the TCOC for those who received less than three days of hospice care (HC) a...

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Main Authors: J. Russell Hoverman, B. Brooke Mann, Sara Phu, Philip Nelson, Jad E. Hayes, Cynthia B. Taniguchi, Marcus A. Neubauer
Format: Article
Language:English
Published: Mary Ann Liebert 2020-06-01
Series:Palliative Medicine Reports
Subjects:
Online Access:https://www.liebertpub.com/doi/full/10.1089/PMR.2020.0023
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author J. Russell Hoverman
B. Brooke Mann
Sara Phu
Philip Nelson
Jad E. Hayes
Cynthia B. Taniguchi
Marcus A. Neubauer
author_facet J. Russell Hoverman
B. Brooke Mann
Sara Phu
Philip Nelson
Jad E. Hayes
Cynthia B. Taniguchi
Marcus A. Neubauer
author_sort J. Russell Hoverman
collection DOAJ
description Background: End-of-life management is a difficult aspect of cancer care. With the oncology care model (OCM), we have data to assess both clinical outcomes and total cost of care (TCOC). Objective: To measure and characterize the TCOC for those who received less than three days of hospice care (HC) at the end of life compared with those who received three days or more. Design: Assess data on costs and site and date of death from Medicare claims on patients identified in the OCM who received chemotherapy in the six months before death. Standard statistical methods were used to characterize both populations. Setting/Subjects: Subjects were Medicare patients with cancer who died while managed by U.S. oncology practices in the OCM. Measurements were TCOC in 30-day intervals for the last months of life, cost by site of care at the end of life, and demographic characteristics of the population and association with HC. Results: There were 7329 deaths. Dying in the hospital was twice the cost of dying at home under HC ($20,113 vs. $10,803). Of demographic groups measured, only black race and a lymphoma diagnosis had <50% hospice enrollment for three days or more before death. Conclusions: This study reinforces previous studies regarding costs in the last 30 days of life. The graphic representation highlights the dollar cost and the costs of lost opportunity. Using these data to improve communication, addressing socioeconomic support, and formal palliative care integration are potential strategies to improve care.
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spelling doaj.art-cc9d916b342344a4b3ca5060190e966c2024-01-26T04:46:50ZengMary Ann LiebertPalliative Medicine Reports2689-28202020-06-0111929610.1089/PMR.2020.0023Hospice or Hospital: The Costs of Dying of Cancer in the Oncology Care ModelJ. Russell HovermanB. Brooke MannSara PhuPhilip NelsonJad E. HayesCynthia B. TaniguchiMarcus A. NeubauerBackground: End-of-life management is a difficult aspect of cancer care. With the oncology care model (OCM), we have data to assess both clinical outcomes and total cost of care (TCOC). Objective: To measure and characterize the TCOC for those who received less than three days of hospice care (HC) at the end of life compared with those who received three days or more. Design: Assess data on costs and site and date of death from Medicare claims on patients identified in the OCM who received chemotherapy in the six months before death. Standard statistical methods were used to characterize both populations. Setting/Subjects: Subjects were Medicare patients with cancer who died while managed by U.S. oncology practices in the OCM. Measurements were TCOC in 30-day intervals for the last months of life, cost by site of care at the end of life, and demographic characteristics of the population and association with HC. Results: There were 7329 deaths. Dying in the hospital was twice the cost of dying at home under HC ($20,113 vs. $10,803). Of demographic groups measured, only black race and a lymphoma diagnosis had <50% hospice enrollment for three days or more before death. Conclusions: This study reinforces previous studies regarding costs in the last 30 days of life. The graphic representation highlights the dollar cost and the costs of lost opportunity. Using these data to improve communication, addressing socioeconomic support, and formal palliative care integration are potential strategies to improve care.https://www.liebertpub.com/doi/full/10.1089/PMR.2020.0023cancer chemotherapycost of care at end of lifehospice oncologypalliative oncology
spellingShingle J. Russell Hoverman
B. Brooke Mann
Sara Phu
Philip Nelson
Jad E. Hayes
Cynthia B. Taniguchi
Marcus A. Neubauer
Hospice or Hospital: The Costs of Dying of Cancer in the Oncology Care Model
Palliative Medicine Reports
cancer chemotherapy
cost of care at end of life
hospice oncology
palliative oncology
title Hospice or Hospital: The Costs of Dying of Cancer in the Oncology Care Model
title_full Hospice or Hospital: The Costs of Dying of Cancer in the Oncology Care Model
title_fullStr Hospice or Hospital: The Costs of Dying of Cancer in the Oncology Care Model
title_full_unstemmed Hospice or Hospital: The Costs of Dying of Cancer in the Oncology Care Model
title_short Hospice or Hospital: The Costs of Dying of Cancer in the Oncology Care Model
title_sort hospice or hospital the costs of dying of cancer in the oncology care model
topic cancer chemotherapy
cost of care at end of life
hospice oncology
palliative oncology
url https://www.liebertpub.com/doi/full/10.1089/PMR.2020.0023
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