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Intensity of end-of-life care for gynecologic cancer patients by primary oncologist specialty
  1. Katherine Hicks-Courant1,
  2. Genevieve P Kanter2,3,
  3. Marilyn M Schapira3,4,
  4. Colleen M Brensinger5,
  5. Qing Liu5 and
  6. Emily Meichun Ko1
  1. 1Division of Gynecologic Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  3. 3Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  4. 4Center for Health Equity Research & Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
  5. 5Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
  1. Correspondence to Dr Katherine Hicks-Courant, Division of Gynecologic Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; katherine.hicks-courant{at}pennmedicine.upenn.edu

Abstract

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.

  • Gynecology
  • 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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Data availability statement

Data may be obtained from a third party and are not publicly available.

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Footnotes

  • Twitter @khickscourant

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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