title: Chemotherapy Use in the Months Before Death and Estimated Costs of Care in the Last Week of Life.
abstract: Considerable attention has been paid to the disproportionately high costs of care for patients nearing death, yet little is known about the costs associated with chemotherapy use among end-stage cancer patients.
  
  
  
  To compare costs of care other than chemotherapy in the last week of life based on whether cancer patients were using chemotherapy in the months just before death.
  
  
  
  A total of 311 patients with advanced cancer who died between 2002 and 2008 were studied. Data included medical records, patient baseline surveys (median four months before death), and postmortem interviews of caregivers and clinicians. Costs of care were estimated based on reports of death site and services other than chemotherapy received in the week before death (e.g., resuscitation). We tested whether end-of-life (EOL) care preferences, do-not-resuscitate order completion, or EOL discussions accounted for relationships between chemotherapy use and estimated care costs.
  
  
  
  Half (50.5%) of patients were receiving chemotherapy at baseline. Estimated EOL care costs for patients with baseline chemotherapy use (median = $2681) were significantly higher than for patients without baseline chemotherapy use (median = $1092) (P = 0.003). This relationship persisted after adjusting for sociodemographic and clinical characteristics in a generalized linear model (mean incremental cost = $2681, 95% confidence interval $611-$4751, P = 0.01). None of the psychosocial variables accounted for the relationship between chemotherapy use and estimated care costs.
  
  
  
  Chemotherapy for end-stage cancer patients is associated with higher estimated EOL care costs. Given evidence of limited benefit and potential harm of chemotherapy for end-stage cancer patients, the cost-effectiveness of such care is questioned and further study warranted.
authors.affiliation: James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA; Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Garrido
authors.affiliation: Weill Cornell Medical College, New York, New York, USA. Electronic address: hgp2001@med.cornell.edu.
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
authors.affiliation: Weill Cornell Medical College, New York, New York, USA.
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Bao
authors.affiliation: Weill Cornell Medical College, New York, New York, USA.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Maciejewski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D005260:Female; D017048:Health Care Costs / Q000639:trends; D006801:Humans; D007407:Interviews as Topic; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D010820:Physicians; D011446:Prospective Studies; D012044:Regression Analysis; D016414:Resuscitation Orders; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000191:economics* / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Chemotherapy; advanced cancer; costs of care; end of life; financial toxicity