title: Chemotherapy use among Medicare beneficiaries at the end of life.
abstract: BACKGROUND
  Although many observers believe that cancer chemotherapy is overused at the end of life, there are no published data on this.
  
  
  OBJECTIVE
  To determine the frequency and duration of chemotherapy use in the last 6 months of life stratified by type of cancer, age, and sex.
  
  
  METHODS
  Retrospective cohort analysis.
  
  
  METHODS
  Administrative databases from Massachusetts and California.
  
  
  METHODS
  All Medicare patients who died of cancer in Massachusetts and 5% of Medicare cancer decedents in California in 1996.
  
  
  METHODS
  Use of intravenous chemotherapy agents, chemotherapy administration, or medical evaluation for chemotherapy from Medicare billing data for each patient in 30-day periods from the date of death backward.
  
  
  RESULTS
  In Massachusetts, 33% of cancer decedents older than 65 years of age received chemotherapy in the last 6 months of life, 23% in the last 3 months, and 9% in the last month. In California, the percentages were 26%, 20%, and 9%, respectively. Chemotherapy use greatly declined with age. Chemotherapy use was similar for patients with breast, colon, and ovarian cancer and those with cancer generally considered unresponsive to chemotherapy, such as pancreatic, hepatocellular, or renal-cell cancer or melanoma. Patients with types of cancer that are unresponsive to chemotherapy had shorter duration of chemotherapy use.
  
  
  CONCLUSIONS
  Among patients who died of cancer, chemotherapy was used frequently in the last 3 months of life. The cancer's responsiveness to chemotherapy does not seem to influence whether dying patients receive chemotherapy at the end of life.
authors.affiliation: Department of Clinical Bioethics, Warren G. Magnuson Clinical Center, National Institutes of Health, Building 10, Room 1C118, Bethesda, Maryland 20892-1156, USA.
authors.forename: Ezekiel J
authors.initials: EJ
authors.lastname: Emanuel
authors.forename: Yinong
authors.initials: Y
authors.lastname: Young-Xu
authors.forename: Norman G
authors.initials: NG
authors.lastname: Levinsky
authors.forename: Gail
authors.initials: G
authors.lastname: Gazelle
authors.forename: Olga
authors.initials: O
authors.lastname: Saynina
authors.forename: Arlene S
authors.initials: AS
authors.lastname: Ash
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002140:California; D015331:Cohort Studies; D004363:Drug Utilization; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts; D006278:Medicare; D010166:Palliative Care; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013727:Terminal Care
chemical_list: D000970:Antineoplastic Agents