Chemotherapy use among Medicare beneficiaries at the end of life.
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.
Emanuel
Ezekiel J
EJ
Department of Clinical Bioethics, Warren G. Magnuson Clinical Center, National Institutes of Health, Building 10, Room 1C118, Bethesda, Maryland 20892-1156, USA.
Young-Xu
Yinong
Y
Levinsky
Norman G
NG
Gazelle
Gail
G
Saynina
Olga
O
Ash
Arlene S
AS
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
D000970:Antineoplastic Agents