High Intensity of End-of-Life Care Among Adolescent and Young Adult Cancer Patients in the New York State Medicaid Program.
BACKGROUND
Little is known about the care that adolescent and young adult (AYA) cancer patients receive at the end of life (EOL).


OBJECTIVE
To evaluate use of intensive measures and hospice and location of death of AYA cancer patients insured by Medicaid in New York State.


METHODS
Using linked patient-level data from the New York State Cancer Registry and state Medicaid program, we identified 705 Medicaid patients who were diagnosed with cancer between the ages of 15 and 29 in the years 2004-2011, who subsequently died, and who were continuously enrolled in Medicaid in the last 60 days of life. We evaluated use of intensive EOL measures (chemotherapy within 14 d of death; intensive care unit care, >1 emergency room visit, and hospitalizations in the last 30 d of life), hospice use, and location of death (inpatient hospice, long-term care facility, acute care facility, home with hospice, home without hospice).


RESULTS
75% of AYA Medicaid decedents used at least 1 aspect of intensive EOL care. 38% received chemotherapy in the last 2 weeks of life; 21% received intensive care unit care, 44% had >1 emergency room visit, and 64% were hospitalized in the last month of life. Only 23% used hospice. 65% of patients died in acute care settings, including the inpatient hospital or emergency room.


CONCLUSIONS
Given the high rates of intensive measures and low utilization of hospice at the EOL among AYA Medicaid enrollees, opportunities to maximize the quality of EOL care in this high-risk group should be prioritized.
*Department of Pediatric Oncology †The Division of Population Sciences' Center for Outcomes and Policy Research, Dana-Farber Cancer Institute ‡Division of Pediatric Hematology/Oncology, Children's Hospital, Boston, MA §New York State Department of Health, State Cancer Registry ∥New York State Department of Health, Office of Quality and Patient Safety, Albany, NY ¶Medical Oncology, Dana-Farber Cancer Institute, Boston, MA.
Jennifer W
JW
Mack
Kun
K
Chen
Francis P
FP
Boscoe
Foster C
FC
Gesten
Patrick J
PJ
Roohan
Maria J
MJ
Schymura
Deborah
D
Schrag
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006738:Hospices / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D009369:Neoplasms / Q000628:therapy*; D009518:New York; D010343:Patient Admission / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013727:Terminal Care / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult
D000970:Antineoplastic Agents