title: End-of-life care in Medicare beneficiaries dying with pancreatic cancer.
abstract: BACKGROUND
  The authors' goal was to characterize hospice enrollment and aggressiveness of care for pancreatic cancer patients at the end of life.
  
  
  METHODS
  Surveillance, Epidemiology, and End Results and linked Medicare claims data (1992-2006) were used to identify patients with pancreatic cancer who had died (n = 22,818). The authors evaluated hospice use, hospice enrollment ≥ 4 weeks before death, and aggressiveness of care as measured by receipt of chemotherapy, acute care hospitalization, and intensive care unit (ICU) admission in the last month of life.
  
  
  RESULTS
  Overall, 56.9% of patients enrolled in hospice, and 35.9% of hospice users enrolled for 4 weeks or more. Hospice use increased from 36.2% in 1992-1994 to 67.2% in 2004-2006 (P < .0001). Admission to the ICU and receipt of chemotherapy in the last month of life increased from 15.5% to 19.6% (P < .0001) and from 8.1% to 16.4% (P < .0001), respectively. Among patients with locoregional disease, those who underwent resection were less likely to enroll in hospice before death and much less likely to enroll early. They were also more likely to receive chemotherapy (14% vs 9%, P < .0001), be admitted to an acute care hospital (61% vs 53%, P < .0001), and be admitted to an ICU (27% vs 15%, P < .0001) in the last month of life.
  
  
  CONCLUSIONS
  Although hospice use increased over time, there was a simultaneous decrease in early enrollment and increase in aggressive care at the end of life for patients with pancreatic cancer.
authors.affiliation: Department of Surgery, University of Texas Medical Branch, Galveston, Texas 77555-0541, USA. kmsheffi@utmb.edu
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Sheffield
authors.forename: Casey A
authors.initials: CA
authors.lastname: Boyd
authors.forename: Jamie
authors.initials: J
authors.lastname: Benarroch-Gampel
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
authors.forename: Catherine D
authors.initials: CD
authors.lastname: Cooksley
authors.forename: Taylor S
authors.initials: TS
authors.lastname: Riall
mesh_terms: D000293:Adolescent; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D006278:Medicare; D010190:Pancreatic Neoplasms / Q000628:therapy*; D013727:Terminal Care; D013997:Time Factors; D014481:United States
chemical_list: D000970:Antineoplastic Agents