One step forward, two steps back: Trends in aggressive inpatient care at the end of life for patients with stage IV lung cancer Journal Article


Authors: Mrad, C.; Abougergi, M. S.; Daly, B.
Article Title: One step forward, two steps back: Trends in aggressive inpatient care at the end of life for patients with stage IV lung cancer
Abstract: Background: Patients with metastatic lung cancer are treated with palliative intent. Aggressive care at the end of life is a marker of poor-quality care. National trends and factors related to aggressive inpatient care at the end of life for these patients have not been evaluated. Methods: Patients with stage IV lung cancer and a terminal hospitalization were identified in the National Inpatient Sample database between 1998 and 2014. Longitudinal analysis was conducted to determine trends in aggressive inpatient care at the end of life and multivariate logistic regression was performed to determine associations with patient and hospital characteristics. Results: A total of 412,946 patients met the inclusion criteria. From 1998 to 2014, the proportion of patients admitted to the intensive care unit (ICU) during the terminal hospitalization increased from 13.3% to 27.9% (P, .001). The ICU stay translated into a higher mean total cost of care (+$18,461; 95% CI, $17,460 to $19,463). Promisingly, palliative care encounters for terminal hospitalizations also increased during this period from 8.7% to 53.0% (P, .01) and were correlated with a decrease in aggressive care at the end of life. However, this did not offset the trend in increased ICU use; mean total costs for a terminal hospitalization increased from $14,000 to $19,500, adjusted for inflation. A multivariable model demonstrates variation by patient and hospital characteristics in aggressive care use. Conclusions: Among patients with metastatic lung cancer there has been a substantial increase in ICU use during terminal hospitalizations, resulting in high cost for the health care system. Copyright © 2018 by American Society of Clinical Oncology
Journal Title: Journal of Oncology Practice
Volume: 14
Issue: 12
ISSN: 1554-7477
Publisher: American Society of Clinical Oncology  
Date Published: 2018-01-01
Start Page: e746
End Page: e757
Language: English
DOI: 10.1200/jop.18.00515
PROVIDER: scopus
PUBMED: 30265173
DOI/URL:
Notes: Export Date: 2 January 2019 -- Article -- Source: Scopus
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  1. Robert M Daly
    78 Daly