title: Utilization of surgery, chemotherapy, radiation therapy, and hospice at the end of life for patients diagnosed with metastatic melanoma.
abstract: OBJECTIVE
  To examine the patterns of utilization of radiation therapy, chemotherapy, surgery, and hospice at the end-of-life care for patients diagnosed with metastatic melanoma.
  
  
  METHODS
  We identified 816 Medicare beneficiaries toward who were 65 years of age or older, with pathologically confirmed metastatic malignant melanoma between January 1, 2000, and December 31, 2007. We evaluated trends and associations between sociodemographic and health service characteristics and the use of hospice care, chemotherapy, surgery, and radiation therapy.
  
  
  RESULTS
  We found increasing use of surgery for patients with metastatic melanoma from 13% in 2000 to 30% in 2007 (P=0.03 for trend), and no significant fluctuation in the use of chemotherapy (P=0.43) or radiation therapy (P=0.46). Older patients were less likely to receive radiation therapy or chemotherapy. The use of hospice care increased from 61% in 2000 to 79% in 2007 (P=0.07 for trend). Enrollment in short-term (1 to 3 d) hospice care use increased, whereas long-term hospice care (≥4 d) remained stable. Patients living in the SEER (Surveillance, Epidemiology and End Results) northeast and south regions were less likely to undergo surgery. Patients enrolled in long-term hospice care used significantly less chemotherapy, surgery, and radiation therapy.
  
  
  CONCLUSIONS
  Surgery and hospice care use increased over the years of this study, whereas the use of chemotherapy and radiation therapy remained consistent for patients diagnosed with metastatic melanoma.
authors: Departments of *Radiation Oncology ∥Biostatistics, University of Texas MD Anderson Cancer Center Divisions of †Management, Policy and Community Health ‡Epidemiology, Human Genetics, and Environmental Sciences §Biostatistics, University of Texas School of Public Health, Houston, TX.
authors: Jinhai
authors: J
authors: Huo
authors: Xianglin L
authors: XL
authors: Du
authors: David R
authors: DR
authors: Lairson
authors: Wenyaw
authors: W
authors: Chan
authors: Jing
authors: J
authors: Jiang
authors: Thomas A
authors: TA
authors: Buchholz
authors: B Ashleigh
authors: BA
authors: Guadagnolo
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D004358:Drug Therapy / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008545:Melanoma / Q000556:secondary / Q000628:therapy*; D011878:Radiotherapy / Q000706:statistics & numerical data / Q000639:trends*; D018426:SEER Program / Q000706:statistics & numerical data; D012878:Skin Neoplasms / Q000473:pathology / Q000628:therapy*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data / Q000639:trends*; D013727:Terminal Care / Q000706:statistics & numerical data / Q000639:trends; D014481:United States
chemical_list: D000970:Antineoplastic Agents
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