title: Escalation of oncologic services at the end of life among patients with gynecologic cancer at an urban, public hospital.
abstract: OBJECTIVE
  Use of oncology-related services is increasingly scrutinized, yet precisely which services are actually rendered to patients, particularly at the end of life, is unknown. This study characterizes the end-of-life use of medical services by patients with gynecologic cancer at a safety-net hospital.
  
  
  METHODS
  Oncologic history and metrics of medical use (eg, hospitalizations, chemotherapy infusions, procedures) for patients with gynecologic oncology who died between December 2006 and February 2012 were evaluated. Mixed-effect regression models were used to test time effects and construct usage summaries.
  
  
  RESULTS
  Among 116 subjects, cervical cancer accounted for the most deaths (42%). The median age at diagnosis was 55 years; 63% were Hispanic, and 65% had advanced disease. Only 34% died in hospice care. The median times from do not resuscitate/do not intubate documentation and from last therapeutic intervention to death were 9 days and 55 days, respectively. Significant time effects for all services (eg, hospitalizations, diagnostics, procedures, treatments, clinic appointments) were detected during the patient's final year (P < .001), with the most dramatic changes occurring during the last 2 months. Patients with longer duration of continuity of care used significantly fewer resources toward the end of life.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report enumerating medical services obtained by patients with gynecologic cancer in a large, public hospital during the end of life. Marked changes in interventions in the patient's final 2 months highlight the need for cost-effective, evidence-based metrics for delivering cancer care. Our data emphasize continuity of care as a significant determinant of oncologic resource use during this critical period.
authors.affiliation: Los Angeles County and University of Southern California Healthcare Network; University of Southern California, Keck School of Medicine; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles; and Ventura County Medical System, Ventura, CA.
authors.forename: Eijean
authors.initials: E
authors.lastname: Wu
authors.affiliation: Los Angeles County and University of Southern California Healthcare Network; University of Southern California, Keck School of Medicine; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles; and Ventura County Medical System, Ventura, CA.
authors.forename: Anna
authors.initials: A
authors.lastname: Rogers
authors.affiliation: Los Angeles County and University of Southern California Healthcare Network; University of Southern California, Keck School of Medicine; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles; and Ventura County Medical System, Ventura, CA.
authors.forename: Lingyun
authors.initials: L
authors.lastname: Ji
authors.affiliation: Los Angeles County and University of Southern California Healthcare Network; University of Southern California, Keck School of Medicine; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles; and Ventura County Medical System, Ventura, CA.
authors.forename: Richard
authors.initials: R
authors.lastname: Sposto
authors.affiliation: Los Angeles County and University of Southern California Healthcare Network; University of Southern California, Keck School of Medicine; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles; and Ventura County Medical System, Ventura, CA.
authors.forename: Terry
authors.initials: T
authors.lastname: Church
authors.affiliation: Los Angeles County and University of Southern California Healthcare Network; University of Southern California, Keck School of Medicine; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles; and Ventura County Medical System, Ventura, CA.
authors.forename: Lynda
authors.initials: L
authors.lastname: Roman
authors.affiliation: Los Angeles County and University of Southern California Healthcare Network; University of Southern California, Keck School of Medicine; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles; and Ventura County Medical System, Ventura, CA.
authors.forename: Debu
authors.initials: D
authors.lastname: Tripathy
authors.affiliation: Los Angeles County and University of Southern California Healthcare Network; University of Southern California, Keck School of Medicine; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles; and Ventura County Medical System, Ventura, CA yglin@alum.mit.edu.
authors.forename: Yvonne G
authors.initials: YG
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002947:Cities; D005260:Female; D005833:Genital Neoplasms, Female / Q000175:diagnosis / Q000628:therapy; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D064876:Safety-net Providers / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000706:statistics & numerical data*