title: End-of-life hospital costs in cancer patients: do advance directives or routes of hospital admission make a difference?
abstract: OBJECTIVE
  End-of-life cancer care is costly. The current study explored whether advance directives or route of hospital admission reduced cancer patients' terminal hospitalization costs.
  
  
  METHODS
  This single-institution study focused on solid tumor patients who died on an inpatient oncology service in 2008 and 2009. Patients' total costs were compared based on advance directives and route of hospitalization.
  
  
  RESULTS
  Among 120 patients, all except 4 had an incurable malignancy. Forty-six (38%) had an advance directive. Sixteen (13%) were admitted after an oncology clinic visit and 6 (5%) from hospice; others were admitted via other routes, most commonly from the emergency department. The median total cost for hospitalization (range) per patient was USD 12,962 (1,244-138,877). Patients with advance directives had no statistically significant difference in cost (p = 0.30), even after adjusting for age and time in the hospital. Those admitted after an oncology clinic or from hospice also had no difference in cost compared to those admitted via another route. Use of cardiopulmonary resuscitation, intensive care unit monitoring and intubation were similar between all compared groups.
  
  
  CONCLUSIONS
  Advance directives and route of admission do not appear to impact the cost of terminal hospitalization for cancer patients.
authors.affiliation: Department of Oncology, Mayo Clinic, Rochester, Minn., USA.
authors.forename: Tow S
authors.initials: TS
authors.lastname: Tan
authors.forename: Aminah
authors.initials: A
authors.lastname: Jatoi
mesh_terms: D000328:Adult; D016223:Advance Directives / Q000191:economics*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009369:Neoplasms / Q000628:therapy; D010343:Patient Admission / Q000191:economics*; D013727:Terminal Care / Q000191:economics*; D055815:Young Adult