title: Impact of aggressive management and palliative care on cancer costs in the final month of life.
abstract: BACKGROUND
  A significant share of the cost of cancer care is concentrated in the end-of-life period. Although quality measures of aggressive treatment may guide optimal care during this timeframe, little is known about whether these metrics affect costs of care.
  
  
  METHODS
  This study used population data to identify a cohort of patients who died of cancer in Ontario, Canada (2005-2009). Individuals were categorized as having received or having not received aggressive end-of-life care according to quality measures related to acute institutional care or chemotherapy administration in the end-of-life period. Costs (2009 Canadian dollars) were collected over the last month of life through the linkage of health system administrative databases. Multivariate quantile regression was used to identify predictors of increased costs.
  
  
  RESULTS
  Among 107,253 patients, the mean per-patient cost over the final month was $18,131 for patients receiving aggressive care and $12,678 for patients receiving nonaggressive care (P < .0001). Patients who received chemotherapy in the last 2 weeks of life also sustained higher costs than those who did not (P < .0001). For individuals receiving end-of-life care in the highest cost quintile, early and repeated palliative care consultation was associated with reduced mean per-patient costs. In a multivariate analysis, chemotherapy in the 2 weeks of life remained predictive of increased costs (median increase, $536; P < .0001), whereas access to palliation remained predictive for lower costs (median decrease, $418; P < .0001).
  
  
  CONCLUSIONS
  Cancer patients who receive aggressive end-of-life care incur 43% higher costs than those managed nonaggressively. Palliative consultation may partially offset these costs and offer resultant savings.
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Cheung
authors.affiliation: Ontario Institute for Cancer Research, Toronto, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Jagadish
authors.initials: J
authors.lastname: Rangrej
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Thi H
authors.initials: TH
authors.lastname: Ho
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Ning
authors.initials: N
authors.lastname: Liu
authors.affiliation: Odette Cancer Centre, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Barbera
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Refik
authors.initials: R
authors.lastname: Saskin
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Joan
authors.initials: J
authors.lastname: Porter
authors.affiliation: Health Outcomes and Pharmacoeconomic Research Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Soo Jin
authors.initials: SJ
authors.lastname: Seung
authors.affiliation: Health Outcomes and Pharmacoeconomic Research Centre, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.|Canadian Centre for Applied Research in Cancer Control, Toronto, Canada.|Department of Pharmacology, University of Toronto, Toronto, Canada.|International Centre for Health Innovation, Richard Ivey Business School, Western University, London, Canada.
authors.forename: Nicole
authors.initials: N
authors.lastname: Mittmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000191:economics* / Q000628:therapy*; D010166:Palliative Care / Q000191:economics*; D013727:Terminal Care / Q000191:economics*
keywords: chemotherapy; costs; end-of-life care; palliative care; quality measures