Hospital-based end-of-life (EOL) care for older patients with malignant brain tumors is associated with over $16,000 in expenses per patient, according to a research letter published in JAMA Oncology (published online June 22, 2017; doi:10.1001/jamaoncol.2017.1624).
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More than half of patient diagnosed with a primary malignant brain tumor or secondary malignant brain tumor are older than 65 years and experience disproportionate mortality and symptom burden. EOL care for such patients tends to be aggressive, costly, and without regard to patient preference. A general lack of knowledge exists about patterns of EOL care for older patients with a malignant brain tumor.
Laura L Dover, MD, department of radiation oncology, University of Alabama at Birmingham, and colleagues conducted a study to compare hospital-based care and costs in the last 130 days of life for older patients with primary or secondary malignant brain tumors, identify potential risk factors for aggressive care, and evaluate the association between aggressive care and cost. Researchers used data from 1323 patients with primary (n = 383) or secondary (n = 940) malignant brain tumors.
During the last 30 days of life, researchers found that patients with secondary tumors had a greater likelihood of an emergency department visit (50% vs 40%; P < .001) or hospitalization (50% vs 42%; P = .009) than patients with primary tumors.
Total costs to Medicare were $8592 in the primary tumor group and $9964 in the secondary tumor group. Over half of the total patient population used hospital-based care. Younger men with secondary tumors were more likely to receive hospital-based care.
Among the patients in the primary tumor cohort, likelihood of hospital-based care increased among men and those with a Charlson comorbidity score of 1 or higher. In the secondary tumor cohort, risk factors for hospital-based care included a Charlson score of 1 or higher and increased age.
Researchers reported that hospital-based care increased costs in patients with primary ($16,303) and secondary ($13,132) tumors. These costs can be attributed to unprepared or unexperienced caretakers for the management of EOL symptoms, they wrote.
“These findings underscore the need for interventions that facilitate earlier communication about common illness trajectories and care preferences in the brain tumor population — specifically, discussions about how and where the patient would like to manage a foreseeable neurologic decline,” researchers concluded.—Zachary Bessette
