Objective The association of primary oncologist specialty, medical oncology versus gynecologic oncology, on intensity of care at the end of life in elderly patients with gynecologic cancer is unclear.
Methods This retrospective cohort study used Surveillance, Epidemiology and End Results-Medicare (SEER-M) data. Subjects were fee-for-service Medicare enrollees aged 65 years and older who died of a gynecologic cancer between January 2006 and December 2015. The primary outcome was a composite score for high-intensity care received in the last month of life. Secondary outcomes included invasive procedures and Medicare spending in the last month of life. Simple and multivariable linear and logistic regression analyses evaluated differences in outcomes by primary oncologist specialty. Linear regressions were repeated after creating a more similar control group through nearest-neighbor propensity score matching.
Results Of 12 189 patients, 7705 (63%) had a medical primary oncologist in the last year of life. In adjusted analyses, patients with a gynecologic versus medical primary oncologist received lower rates of high-intensity end-of-life care (53.9% vs 56.6%; p=0.018). Results were similar for the propensity score-matched cohorts. However, having a gynecologic versus medical primary oncologist was associated with higher rates of invasive procedures in the last month of life (43% vs 41%; p=0.014) and higher Medicare spending ($83 859 vs $74 849; p=0.004).
Conclusions Both specialties engage in overall high levels of intense end-of-life care, with differences by specialty in aspects of aggressive care and spending at the end of life. Physician-level training could be a target for educational or quality improvement initiatives to improve end-of-life cancer care delivery.
- Quality of Life (PRO)/Palliative Care
Data availability statement
Data may be obtained from a third party and are not publicly available.
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Presented at Preliminary results of this study have been presented at the Mid-Atlantic Gynecologic Oncology Society Annual Meeting (October 2020), the Society of Gynecologic Oncology Annual Meeting (March 2021), and the American Society of Clinical Oncology Annual Meeting (June 2021).
Contributors KH-C: conceptualization, methodology, software, formal analysis, writing – original draft, writing – review and editing, guarantor. GPK: methodology, formal analysis, writing – review and editing, supervision. MMS: conceptualization, methodology, writing – review and editing, supervision. CMB: software, data curation, writing – review and editing. QL: software, data curation, writing – review and editing. EMK: conceptualization, methodology, data curation, project administration, funding acquisition, writing – review and editing, supervision.
Funding This study was supported in part by grants: Leonard Davis Institute 2019 Pilot Grant Program (PI: EMK); American Cancer Society 124268-IRG-78-002-35-IRG (PI: EMK); by the George and Emily McMichael Harrison Fund, Penn Presbyterian Harrison Fund of the University of Pennsylvania Hospital Obstetrics and Gynecology Department (PI: EMK); and a donation in-kind to the University of Pennsylvania Department of Radiation Oncology (PI: Lilie Lin). KHC acts as the guarantor.
Competing interests EMK reports grants from Tesaro, outside the submitted work.
Provenance and peer review Not commissioned; externally peer reviewed.
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