title: Utilization of palliative care and acute care services in older adults with advanced cancer.
abstract: OBJECTIVE
  There is a gap in knowledge regarding the rates of utilization of palliative care services (PCS) and acute care services (ACS) among older patients with advanced cancer close to end of life. We analyzed the utilization of these services among older adults (65 years and older) and compared them to those in younger adults (40-64 years) with advanced cancer.
  
  
  METHODS
  A retrospective chart review of 567 veterans who died with advanced cancer between 2002 and 2009 and utilized PCS and ACS prior to death was conducted after IRB approval. To assess PCS utilization, we studied the mean duration between day of hospice referral and time of death (DOR) and the mean length of stay with hospice (LoS). The frequency of emergency room visits (ERVLM), hospital admissions (HALM), and ICU admissions (ICULM) in the last month of life was used as a measure for ACS. The differences among older and younger patients were compared using two sample t-tests.
  
  
  RESULTS
  Older adults had earlier referral to PCS [mean DOR: 47.3 versus 34.5 days, p=0.015], longer stay with hospice [mean LoS: 32.5 versus 20.2 days, p=0.007], fewer hospital [HALM: 0.7 versus 0.9, p=0.043], and ICU admissions [ICULM: 0.1 versus 0.2, p=0.030] per patient. The proportion of patients utilizing ER visits [53.5 % versus 59.5%, p=0.173] and hospital admissions [58.6% versus 65.1%, p=0.13] in the last month of life was similar in both age groups with fewer older adults utilizing ICU care [13.2% versus 19.5%, p=0.047].
  
  
  CONCLUSIONS
  Older patients with cancer are likely to be referred to PCS earlier than younger patients and spend a longer duration with PCS prior to death. However, there continues to be significant utilization of ACS in all patients with advanced cancer. Better understanding of the goals of care in older adults with cancer and education of oncology providers regarding the need to utilize and integrate palliative care services earlier in the course of disease is imperative.
authors.affiliation: SUNY Upstate University, Department of Medicine, Syracuse, NY 13210, USA; VA Medical Center, Syracuse, NY, USA.
authors.forename: Namita
authors.initials: N
authors.lastname: Sharma
authors.affiliation: SUNY Upstate University, Department of Medicine, Syracuse, NY 13210, USA; VA Medical Center, Syracuse, NY, USA.
authors.forename: Amit M
authors.initials: AM
authors.lastname: Sharma
authors.affiliation: SUNY Upstate University, Department of Public Health and Preventive Medicine, Syracuse, NY 13210, USA.
authors.forename: Martha A
authors.initials: MA
authors.lastname: Wojtowycz
authors.affiliation: SUNY Upstate University, Department of Public Health and Preventive Medicine, Syracuse, NY 13210, USA.
authors.forename: Dongliang
authors.initials: D
authors.lastname: Wang
authors.affiliation: SUNY Upstate University, Department of Medicine, Syracuse, NY 13210, USA; VA Medical Center, Syracuse, NY, USA. Electronic address: gajraa@upstate.edu.
authors.forename: Ajeet
authors.initials: A
authors.lastname: Gajra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly; D017051:Hospice Care / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000628:therapy*; D010166:Palliative Care / Q000706:statistics & numerical data*; D010343:Patient Admission; D012189:Retrospective Studies
keywords: Cancer; Hospice; Older patients; Palliative care services