title: Retrospective studies of end-of-life resource utilization and costs in cancer care using health administrative data: a systematic review.
abstract: BACKGROUND
  There has been an increase in observational studies using health administrative data to examine the nature, quality, and costs of care at life's end, particularly in cancer care.
  
  
  OBJECTIVE
  To synthesize retrospective observational studies on resource utilization and/or costs at the end of life in cancer patients. We also examine the methods and outcomes of studies assessing the quality of end-of-life care.
  
  
  METHODS
  A systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (A Measurement Tool to Assess Systematic Reviews) methodology.
  
  
  METHODS
  We searched MEDLINE, Embase, CINAHL, and York Centre for Research and Dissemination (1990-2011). Independent reviewers screened abstracts of 14,424 articles, and 835 full-text manuscripts were further reviewed. Inclusion criteria were English-language; at least one resource utilization or cost outcome in adult cancer decedents with solid tumors; outcomes derived from health administrative data; and an exclusive end-of-life focus.
  
  
  RESULTS
  We reviewed 78 studies examining end-of-life care in over 3.7 million cancer decedents; 33 were published since 2008. We observed exponential increases in service use and costs as death approached; hospital services being the main cost driver. Palliative services were relatively underutilized and associated with lower expenditures than hospital-based care. The 15 studies using quality indicators demonstrated that up to 38% of patients receive chemotherapy or life-sustaining treatments in the last month of life and up to 66% do not receive hospice/palliative services.
  
  
  CONCLUSIONS
  Observational studies using health administrative data have the potential to drive evidence-based palliative care practice and policy. Further development of quality care markers will enhance benchmarking activities across health care jurisdictions, providers, and patient populations.
authors.affiliation: Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Julia M
authors.initials: JM
authors.lastname: Langton
authors.affiliation: Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Bianca
authors.initials: B
authors.lastname: Blanch
authors.affiliation: Prince of Wales Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia.
authors.forename: Anna K
authors.initials: AK
authors.lastname: Drew
authors.affiliation: Centre for Health Economics Research and Evaluation, The University of Technology Sydney, Sydney, NSW, Australia.
authors.forename: Marion
authors.initials: M
authors.lastname: Haas
authors.affiliation: Cunningham Centre for Palliative Care, Sacred Heart Health Service, NSW, Australia St Vincents' Hospital Clinical School, Faculty of Medicine, The University of New South Wales, NSW, Australia.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Ingham
authors.affiliation: Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia sallie.pearson@sydney.edu.au.
authors.forename: Sallie-Anne
authors.initials: SA
authors.lastname: Pearson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006298:Health Services Administration / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013727:Terminal Care / Q000191:economics / Q000379:methods / Q000592:standards
keywords: Systematic review; cancer; costs; end-of-life; palliative care; patterns of care; resource utilization