Trends in the intensity of end-of-life care for gynecologic cancer patients by primary oncologist specialty

Objectives: To identify trends in the intensity of care at the end of life in elderly patients with gynecologic cancer and to evaluate for differences by primary oncologist specialty. Methods: This retrospective cohort study used Surveillance, Epidemiology and End Results (SEER) Medicare data. Subjects were fee-for-service Medicare enrollees over 65 years old, who had seen a gynecologic or medical oncologist in an outpatient setting in the last year of life, and died of a gynecologic cancer between 2006 and 2015. The primary oncologist was defined as the provider with the majority of outpatient visits in the last year of life. The primary outcome was intensity of care at the end of life, a composite score defined by receipt of chemotherapy in the last 14 days of life, death in the hospital, enrollment in hospice for less than three days, more than one ED visit, more than one hospital admission, spending more than 14 days in the hospital, or any ICU admission in the last 30 days of life. Multivariable linear regression analyses were conducted to evaluate for differences in rates of intense end-of-life care over time and to compare temporal trends by primary oncologist specialty. Results: Most of the 12,189 women in the study primarily saw a medical oncologist (n=7,705, 63.21%). Medical oncologists’ patients were younger, more likely to be White, more likely to be married, less likely to be dual-eligible, more likely to be diagnosed with advanced cancer, and more likely to die of ovarian cancer compared to gynecologic oncologists’ patients. Overall, 55.61% of patients experienced intense end-of-life care. In adjusted analyses, the proportion of intense end-of-life care was significantly greater for patients who received care from a medical oncologist (56.54%) compared to those who received care from a gynecologic oncologist (54.00%; p Download : Download high-res image (72KB) Download : Download full-size image Conclusions: Patients who die of gynecologic cancer experience high rates of intense care at the end of life. From 2006 to 2015, there was no significant change in the rates of intense care at the end-of life, regardless of the primary oncologist's specialty. Further research is needed to understand if intense end-of-life care is also goal-concordant care for patients with gynecologic cancer. In addition, reducing intense end-of-life care may require outpatient interventions that improve identification and preparation of patients who are at the end of life.