title: Understanding Oral Chemotherapy Prescribing Patterns at the End of Life at a Comprehensive Cancer Center: Analysis of a Massachusetts Payer Claims Database.
abstract: OBJECTIVE
  Receipt of chemotherapy in the last 14 days of life is a measure of potential overuse of care. Specific measures defining appropriate end-of-life use of oral agents have not yet been described, and little is known about prescribing patterns.
  
  
  METHODS
  We conducted an exploratory analysis of 371 patients at Dana-Farber Cancer Institute who were covered by the Blue Cross Blue Shield of Massachusetts pharmacy benefit and died during 2012 to 2013. We analyzed processed claims as a surrogate for chemotherapy administration. We compared oral with parenteral chemotherapy claims in the last 6 months of life.
  
  
  RESULTS
  In the last 6 months of life, 294 patients (79%) had chemotherapy claims, including 81 (22%) prescribed an oral agent; 20 patients had claims for oral chemotherapy in the last 30 days of life. For eight patients (40%), this was the initial start of that oral agent. In the last 14 days of life, only 23 patients had chemotherapy claims, including six patients prescribed an oral agent.
  
  
  CONCLUSIONS
  The collection of oral chemotherapy use data through insurance claims was feasible. Processed claims for chemotherapy, including oral, sharply declined during the last 30 days of life, consistent with a shift to palliative management. These results highlight the need for a more comprehensive analysis of oral chemotherapy prescribing patterns and development of specific measures to define the appropriate use of oral chemotherapy at the end of life.
authors.affiliation: Dana-Farber Cancer Institute; Beth Israel Deaconess Medical Center; and Blue Cross Blue Shield of Massachusetts, Boston, MA jzerillo@partners.org.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Zerillo
authors.affiliation: Dana-Farber Cancer Institute; Beth Israel Deaconess Medical Center; and Blue Cross Blue Shield of Massachusetts, Boston, MA.
authors.forename: Sherri O
authors.initials: SO
authors.lastname: Stuver
authors.affiliation: Dana-Farber Cancer Institute; Beth Israel Deaconess Medical Center; and Blue Cross Blue Shield of Massachusetts, Boston, MA.
authors.forename: Belen
authors.initials: B
authors.lastname: Fraile
authors.affiliation: Dana-Farber Cancer Institute; Beth Israel Deaconess Medical Center; and Blue Cross Blue Shield of Massachusetts, Boston, MA.
authors.forename: Anton D
authors.initials: AD
authors.lastname: Dodek
authors.affiliation: Dana-Farber Cancer Institute; Beth Israel Deaconess Medical Center; and Blue Cross Blue Shield of Massachusetts, Boston, MA.
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Jacobson
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D013727:Terminal Care / Q000191:economics* / Q000523:psychology; D014481:United States; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents