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Chest. 2008 Jan;133(1):72-8. Epub 2007 Nov 7.

Trends in end-of-life ICU use among older adults with advanced lung cancer.

Author information

1
Department of Internal Medicine, Division of Allergy, Pulmonary, Immunology, Critical Care and Sleep, University of Texas Medical Branch, Galveston, TX. TX 77555-0561. gulshan.sharma@utmb.edu

Abstract

BACKGROUND:

There is increasing concern about the appropriateness of intensive medical care near the end of life in ICUs throughout the United States. As a result of hospice expansion in the 1990s, we hypothesized that ICU use decreased over time in older adults with advanced lung cancer.

METHODS:

Retrospective analysis using the linked Surveillance, Epidemiology and End Results Medicare database. There were 45,627 Medicare beneficiaries > or = 66 years of age with confirmed stage IIIB or IV lung cancer between January 1, 1992, and December 31, 2002, who died within a year of their cancer diagnosis from 1993 through 2002.

RESULTS:

ICU use in the last 6 months of life increased from 17.5% in 1993 to 24.7% in 2002 (p < 0.001). After adjusting for patient characteristics, there was a 6.6% annual increase in ICU use from 1993 to 2002. During the same period, hospice use had risen from 28.8 to 49.9% (p < 0.001). A total of 6.2% of patients received both end-of-life ICU care and hospice care, a percentage that increased over time. The total health-care cost for Medicare fee-for-service patients during last 6 months was $40,929 for ICU users and $27,160 for non-ICU users (p < 0.001).

CONCLUSION:

Despite increasing hospice use, ICU utilization among older adults dying with advanced lung cancer continued to rise in the United States during the 1990s.

PMID:
17989164
PMCID:
PMC4034445
DOI:
10.1378/chest.07-1007
[Indexed for MEDLINE]
Free PMC Article
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