title: Use of radiation therapy in the last 30 days of life among a large population-based cohort of elderly patients in the United States.
abstract: OBJECTIVE
  Our goal was to evaluate use and associated costs of radiation therapy (RT) in the last month of life among those dying of cancer.
  
  
  METHODS
  We used the Surveillance, Epidemiology, and End Results (SEER) -Medicare linked databases to analyze claims data for 202,299 patients dying as a result of lung, breast, prostate, colorectal, and pancreas cancers from 2000 to 2007. Logistic regression modeling was used to conduct adjusted analyses of potential impacts of demographic, health services, and treatment-related variables on receipt of RT and treatment with greater than 10 days of RT. Costs were calculated in 2009 dollars.
  
  
  RESULTS
  Among the 15,287 patients (7.6%) who received RT in the last month of life, its use was associated with nonclinical factors such as race, gender, income, and hospice care. Of these patients, 2,721 (17.8%) received more than 10 days of treatment. Nonclinical factors that were associated with greater likelihood of receiving more than 10 days of RT in the last 30 days of life included: non-Hispanic white race, no receipt of hospice care, and treatment in a freestanding, versus a hospital-associated facility. Hospice care was associated with 32% decrease in total costs of care in the last month of life among those receiving RT.
  
  
  CONCLUSIONS
  Although utilization of RT overall was low, almost one in five of patients who received RT in their final 30 days of life spent more than 10 of those days receiving treatment. More research is needed into physician decision making regarding use of RT for patients with end-stage cancer.
authors.affiliation: Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. aguadagn@mdanderson.org
authors.forename: B Ashleigh
authors.initials: BA
authors.lastname: Guadagnolo
authors.forename: Kai-Ping
authors.initials: KP
authors.lastname: Liao
authors.forename: Linda
authors.initials: L
authors.lastname: Elting
authors.forename: Sharon
authors.initials: S
authors.lastname: Giordano
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buchholz
authors.forename: Ya-Chen Tina
authors.initials: YC
authors.lastname: Shih
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D017051:Hospice Care / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data; D009369:Neoplasms / Q000191:economics / Q000453:epidemiology / Q000401:mortality / Q000532:radiotherapy*; D011379:Prognosis; D011878:Radiotherapy / Q000191:economics / Q000706:statistics & numerical data*; D018426:SEER Program; D015996:Survival Rate; D014481:United States / Q000453:epidemiology