Presentation Authors: Lee A Hugar, MD, MSCR*, Samia H Lopa, PhD, Jonathan G Yabes, PhD, Pittsburgh, PA, Nathan E Hale, MD, Charleston, WV, Robert M Turner, MD, Mina M Fam, MD, MBA, Liam C Macleod, MD, MPH, Benjamin J Davies, MD, Bruce L Jacobs, MD, MPH, Pittsburgh, PA
Introduction: In the United States, there is significant variation in the aggressiveness and quality of end-of-life care. Up to 50% of Medicare beneficiaries dying with cancer receive aggressive care at the end of life. High levels of aggressive care at the end of life are incongruous with patient preferences and regions with high rates of aggressive end-of-life care have been shown to have poorer outcomes. We aim, for the first time in the literature, to quantify the proportion of bladder cancers patients receiving aggressive end-of-life care.
Methods: We used Surveillance, Epidemiology, and End Results (SEER)-Medicare data to conduct a population-based study of patients who were diagnosed with bladder cancer and died between 2008-2014. Our primary outcome was receipt of aggressive end-of-life care, defined as any of the following occuring in the last 30 days of life: >1 hospital admission, >1 emergency department (ED) visit, any intensive care unit (ICU) admission, receipt of chemotherapy in the last 14 days of life, or death in an acute-care hospital. We examined demographic and clinicopathologic determinants of receiving aggressive end-of-life care. We also assessed for an association between receipt of palliative care and likelihood of receiving aggressive end-of-life care.
Results: Among 13,253 patients, 6861 (52%) experienced at least one measure of aggressive end-of-life care. The most common measure was in-hospital death, at 30%. In the last month of life, 28% of the cohort was admitted to the ICU, 17% had more than 1 ED visit, and 13% had more than one hospital admission (Figure).
Conclusions: Aggressive end-of-life care is prevalent among patients dying with bladder cancer, with over half receiving aggressive care in the last month of life. Over 30% of all bladder cancer patients died in the hospital setting. Future studies must address how patient, physician, and systems factors impact these rates, with the goal of decreasing unnecessary or unwanted aggressive care.