title: End-of-life home care utilization and costs in patients with advanced colorectal cancer.
abstract: OBJECTIVE
  To determine overall utilization and costs associated with home care services in Ontario, Canada by linking a home care database to a stage IV colorectal cancer cohort.
  
  
  METHODS
  The names of patients with stage IV colorectal cancer at time of diagnosis (diagnosed from 2005 through 2009) were extracted from the Ontario Cancer Registry. The study cohort comprised those who died before the end of the study. The terminal phase of care was the period of time between diagnosis and death, with a maximum value of 180 days (6 months). Patients were linked to home care services datasets. The type, frequency, and cost of home care services were determined. Regression analysis was used to examine factors associated with utilization and cost.
  
  
  RESULTS
  In all, 3,613 stage IV colorectal cancer patients (median age, 71 years) were diagnosed and died during the study's time horizon. During the terminal phase, 79.3% received at least 1 home care visit, and 58.0% had at least 1 palliative visit. Terminal metastatic colorectal cancer patients received an average of 8 home care visits at Canadian $800 within a 30-day time horizon. Home care costs were highest in the month before death. Male sex, a history of moderate or high utilization of health care services, and hospitalization were associated with lower home care costs.
  
  
  CONCLUSIONS
  Administrative data do not reveal the purpose, efficiency, effectiveness/sufficiency, quality, or appropriateness of home care.
  
  
  CONCLUSIONS
  Patients with advanced colorectal cancer who were approaching death required a moderate level of home care support, resulting in costs of about $5,000 over the 6-month time horizon.
  
  
  BACKGROUND
  This study was conducted with the support of the Ontario Institute for Cancer Research and Cancer Care Ontario through funding provided by the government of Ontario. Data were provided by Cancer Care Ontario and the Institute for Clinical Evaluative Sciences. The ICES also provided funding for the study from an annual grant by the Ontario Ministry of Health and Long-term Care.
authors: Health Outcomes and PharmacoEconomic (HOPE) Research Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Email: nicole.mittmann@sri.utoronto.ca.
authors: Nicole
authors: N
authors: Mittmann
authors: Ning
authors: N
authors: Liu
authors: Joan M
authors: JM
authors: Porter
authors: Pierre K
authors: PK
authors: Isogai
authors: Refik
authors: R
authors: Saskin
authors: Matthew C
authors: MC
authors: Cheung
authors: Natasha B
authors: NB
authors: Leighl
authors: Jeffrey S
authors: JS
authors: Hoch
authors: Maureen E
authors: ME
authors: Trudeau
authors: William K
authors: WK
authors: Evans
authors: Katie N
authors: KN
authors: Dainty
authors: Craig C
authors: CC
authors: Earle