Use of hospice services among Medicare beneficiaries with acute and chronic leukemias.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 68-68
Author(s):  
Thomas William LeBlanc ◽  
Adam J. Olszewski
Keyword(s):  
Quality Measures ◽  
Hematologic Malignancies ◽  
Time Of Death ◽  
Medicare Beneficiaries ◽  
Annual Percent Change ◽  
Percent Change ◽  
Binomial Regression ◽  
Hospice Use ◽  
Eol Care ◽  
Over Time

68 Background: Studies show lower rates of hospice use among patients (pts) with hematologic malignancies. Our objective was to describe trends in hospice use and in quality measures for end-of-life (EOL) care among Medicare beneficiaries with leukemias. Methods: From the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, we selected pts with acute (myeloid or lymphoblastic) or chronic (lymphocytic, myeloid, or myelomonocytic) leukemias diagnosed in 1996-2011 who died in 2001-2011. We identified hospice enrollment at death, duration of hospice enrollment, inpatient deaths, intensive care unit (ICU) admissions within 30 days of death, and chemotherapy use in the last 14 days of life. We summarized linearized trends by year of death using log-binomial regression, reporting average annual percent change (APC). Results: Among 38,038 leukemia pts (41% acute, median age 78 years) 81% died, after median 2.8 months from diagnosis (95%CI, 2.7-2.9) for acute and 49.1 months (95%CI, 47.9-50.1) for chronic leukemias. Among pts who died in 2001-2011 ( N= 23,941), 42% were enrolled in hospice at the time of death. This proportion significantly increased between 2001 and 2011, from 33% to 48% (APC +4.1%, P< .001), both for acute and chronic leukemias ( Pinteraction= .25). Median time on hospice was 8 days, and the proportion of pts with < 3 days on hospice increased from 20% to 24% between 2001 and 2001 (APC +1.2%, P= .05). Inpatient deaths significantly decreased from 54% to 39%, respectively (APC -3.2%, P< .001), but ICU use at EOL increased from 34% to 41% (APC +2.4%, P< .001). Chemotherapy use at EOL was more frequent in acute (17%) than chronic (6%) leukemia, and decreased for both (overall from 15% to 10%, APC -3.2%, P< .001). Conclusions: The use of hospice services among older pts with leukemia has increased, suggesting its wider acceptance over time. However, the increasing proportion of brief, terminal hospice admissions, and increasing rate of ICU use at EOL reflect persistent barriers to early enrollment in this population. Some measures of aggressiveness of care (inpatient deaths, chemotherapy at EOL) are lower in the community than previously reported from academic centers (El-Jawahri, Cancer 2015).

scholarly journals End-of-life care quality outcomes among Medicare beneficiaries with hematologic malignancies

2020 ◽  
Vol 4 (15) ◽  
pp. 3606-3614
Author(s):  
Pamela C. Egan ◽  
Thomas W. LeBlanc ◽  
Adam J. Olszewski
Keyword(s):  
End Of Life ◽  
Hospital Setting ◽  
Hematologic Malignancies ◽  
Care Quality ◽  
Lower Probability ◽  
Medicare Beneficiaries ◽  
Quality Outcomes ◽  
Adjusted Means ◽  
Hospice Use ◽  
Eol Care

Abstract Patients with hematologic malignancies are thought to receive more aggressive end-of-life (EOL) care and have suboptimal hospice use compared with patients with solid tumors, but descriptions of EOL outcomes from comprehensive cohorts have been lacking. We used the population-based Surveillance, Epidemiology, and End Results–Medicare dataset to describe hospice use and indicators of aggressive EOL care among Medicare beneficiaries who died of hematologic malignancies in 2008-2015. Overall, 56.5% of decedents used hospice services for median 9 days (interquartile range, 3-27), 33.0% died in an acute hospital setting, 36.8% had an intensive care unit (ICU) admission in the last 30 days of life, and 13.3% received chemotherapy within the last 14 days of life. Hospice use was associated with 96% lower probability of inpatient death (adjusted risk ratio [aRR], 0.038; 95% confidence interval [CI], 0.035-0.042), 44% lower probability of an ICU stay in the last 30 days of life (aRR, 0.56; 95% CI, 0.54-0.57), and 62% decrease in chemotherapy use in the last 14 days of life (aRR, 0.38; 95% CI, 0.35-0.41). Hospice enrollees spent on average 41% fewer days as inpatient during the last month of life (adjusted means ratio, 0.59; 95% CI, 0.57-0.60) and had 38% lower mean Medicare spending in the last month of life (adjusted means ratio, 0.62; 95% CI, 0.61-0.64). These associations were consistent across histologic subgroups. In conclusion, EOL care quality outcomes and hospice enrollment were suboptimal among older decedents with hematologic cancers, but hospice use was associated with a consistent decrease in aggressive care at EOL.

scholarly journals End-of-Life Care Quality Outcomes Among Medicare Beneficiaries with Hematologic Malignancies

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 829-829
Author(s):  
Pamela C Egan ◽  
Thomas W. LeBlanc ◽  
Adam J Olszewski
Keyword(s):  
Acute Care ◽  
Research Funding ◽  
Acute Care Hospital ◽  
Hematologic Malignancies ◽  
Care Quality ◽  
Care Hospital ◽  
Medicare Beneficiaries ◽  
Hospice Use ◽  
Eol Care ◽  
Medicare Spending

Abstract Background: Benefits of hospice care for patients with advanced solid cancers have been extensively studied, but they have not been comprehensively documented in hematologic malignancies (HM). Surveys indicate that hematologists harbor concerns about adequacy of hospice services for patients with HM (Odejide et al., Cancer 2017; Hui et al., Ann Oncol 2015). A common perception is that these patients often receive chemotherapy until the very end of life (EOL) and are destined to die in the acute care setting (Sekeres & Gerds, Cancer 2015). They also experience a barrier to hospice use when transfusion dependence develops (LeBlanc et al., Blood 2018). In this context, some authors have questioned whether standard measures of EOL care quality proposed by the National Quality Forum (NQF) should apply to patients with HM, and whether the use of hospice services can improve such measures. Our objective was to describe EOL care quality measures derivable from Medicare administrative claims among patients with HM who did or did not use hospice services. Methods: From the population-based linked SEER-Medicare registry, we selected fee-for-service beneficiaries with leukemias (acute or chronic), myeloma, myeloproliferative neoplasms (MPN), myelodysplastic syndrome (MDS), or lymphoma (any subtype), who died in 2007-2011. We identified beneficiaries who used hospice services, and ascertained claims-based indicators of aggressive EOL care corresponding to select NQF care quality measures: 1) death in acute care hospital, 2) number of days spent in acute care hospital within 30 days of death, 3) intensive care unit (ICU) admission within 30 days of death, 4) use of chemotherapy within 14 days of death, and 5) Medicare spending for care within the last 30 days of life. Binary outcomes were compared in multivariable robust Poisson models (reporting relative risk, RR), count outcomes in negative binomial models, and costs in a log-gamma model. All estimates were reported with 95% confidence intervals (CI). Models were adjusted for age, sex, race, marital status, Medicaid co-insurance (indicator of low socio-economic status), prevalent poverty in the county of residence, comorbidity index, poor performance status indicator, calendar year, and survival from diagnosis. Results: We identified 13,556 decedents with leukemia, 7,910 with myeloma, 9,543 with MPN/MDS, and 22,990 with lymphoma, who had median age at death of 78 years (interquartile range [IQR] 72-84). Overall, 47% of patients used hospice services, enrolling at median 22 months from diagnosis (IQR, 5-59; varying from 13 in leukemia to 28 in lymphoma). Median length of stay on hospice was 9 days (IQR, 3-27), varying from 8 to 10 days between different HM. Overall, 39% of patients died in hospital settings (from 36% in myeloma to 41% in leukemia). Median number of days spent in hospital at EOL was 4 in all types of HM. ICU admissions within the last month of life occurred in 39% of patients, and chemotherapy was administered to 10% in the last 14 days (varying from 7% in MPN/MDS to 13% in leukemia). These measures significantly differed between hospice enrollees and non-enrollees (Table). In multivariable models, use of hospice services was associated with a significant decrease in the aggressiveness of EOL care, as follows: 95% decrease in inpatient deaths (adjusted RR, 0.05; 95%CI, 0.05-0.06), 48% decrease in days spent in hospital (adjusted relative count, 0.62; 95%CI 0.60-0.63), 44% decrease in the risk of ICU stay (adjusted RR, 0.56; 95%CI, 0.54-0.57), 47% decrease in the use of chemotherapy (adjusted RR, 0.53; 95%CI, 0.50-0.57), and 38% decrease in mean Medicare spending at EOL (adjusted relative cost, 0.62; 95%CI, 0.60-0.63). Conclusions: The proportion of Medicare beneficiaries with HM who die in inpatient setting (39%) or are admitted to ICU (39%) in the last month of life is higher than in a contemporary population of Medicare beneficiaries with cancer (22% and 27%, respectively, in 2009 per Teno et al., JAMA 2013). Across the spectrum of HM, which vary in prognosis and clinical course, use of hospice services is associated with markedly improved measures of EOL care quality, as well as lower Medicare spending in the last month of life. However, only 47% of beneficiaries with HM use hospice services (compared with 59% in Teno et al.). Chemotherapy use at EOL was uncommon, challenging the notion that pervasive chemotherapy is a barrier to hospice use in HM. Disclosures Olszewski: Genentech: Research Funding; Spectrum Pharmaceuticals: Consultancy, Research Funding; TG Therapeutics: Research Funding.

The Difference in the Incidence and the Trend of Malignant Lymphomas in Japan and the United States.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2695-2695
Author(s):  
Dai Chihara ◽  
Hidemi Ito ◽  
Tomohiro Matsuda ◽  
Akiko Shibata ◽  
Tomotaka Sobue ◽  
...  
Keyword(s):  
Cancer Registry ◽  
Hematologic Malignancies ◽  
The United States ◽  
Cumulative Exposure ◽  
Malignant Lymphomas ◽  
Annual Percent Change ◽  
Percent Change ◽  
Nodular Sclerosis ◽  
The Us ◽  
The Difference

Abstract Abstract 2695 Background: Malignant lymphomas (ML) are heterogeneous groups that the detailed classification is evolving dramatically. An incidence of malignant disease in certain population reflects cumulative exposure to environment, genetics and their combination overtime. Therefore, a comparison of incidences in various population and their secular trends is very helpful to understand etiology of disease. The aim of this study is to assess the incidence and the trend of each ML subtypes and to evaluate the difference between Japan and US. Materials and Methods: We used the data from a population-based cancer registry in Japan and from the Surveillance Epidemiology and End Results (SEER) program 9. Registry data of the US, SEER 9 included 95,155 cases and the data of Japan included 48,658 cases. The period covered in this analyses was 1993 to 2006 in Japan and 1993 to 2008 in the US. Rates of sex-specific, age-standardized incidence with 95% confidence intervals were estimated and standardized by age-adjustment according to the world standard population. We also estimated the annual percent change using joinpoint regression analysis and evaluated the significance of the trend. Results: The overall age-standardized incidence rate of all malignant lymphomas per 100,000 in 2006 was 22.4 for males and 16.0 for females in the US, 7.4 for males and 4.9 for females in Japan. The incidence is higher in the US than Japan with most of the subtypes especially for the nodular sclerosis HL, CLL/SLL and FL. In general, B-cell lymphomas showed large difference in incidence while T-cell lymphomas (TCL) showed similar incidence between Japan and the US. The total numbers of ML are constantly increasing in Japan but not in the US as shown in the figure {annual percent change (95%CI), Japan; +2.6% (2.1, 3.1), US; +0.2% (−0.0, 0.4)}. As for details, follicular lymphoma, mantle cell lymphoma, Burkitt lymphoma and the total numbers of TCL are constantly increasing in both countries. Conclusion: In conclusion, we showed the marked difference in the incidence and the trend of hematologic malignancies between Japan and the US. The incidence of hematologic malignancies is lower in Japan than the US, but is increasing significantly. The most remarkable difference in the incidence was seen with nodular sclerosis HL, CLL/SLL and FL which was consistent with previous reports. Even with the TCL, the incidence seems to be similar to higher in the US except for the ATLL. The improvement in the quality of cancer registry systems and the organization of these registries between countries enables us to unite the data worldwide that will bring us new insights. Solid line and circle are the data of the US. Dashed line and hollow circle are the data of Japan. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Measuring Quality of End-of-Life Care for Blood Cancers: A National Survey of Hematologic Oncologists

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3290-3290 ◽  
Author(s):  
Oreofe O. Odejide ◽  
Angel M. Cronin ◽  
Nolan B. Condron ◽  
Sean A. Fletcher ◽  
Craig Earle ◽  
...  
Keyword(s):  
End Of Life ◽  
Conflicts Of Interest ◽  
A Priori ◽  
Poor Performance ◽  
Quality Measures ◽  
Hematologic Malignancies ◽  
National Sample ◽  
National Cohort ◽  
Eol Care

Abstract Background: Hematologic malignancies have been associated with poor performance on standard measures of quality of end-of-life (EOL) care in oncology (eg, Hui, Cancer, 2014); however, these measures were originally developed primarily for solid tumors, and they may not appropriately address EOL quality issues for patients with blood cancers. We sought to explore hematologic oncologists' perspectives regarding the acceptability of current oncology EOL quality measures, hypothesizing that they would report them to be largely unacceptable. Methods: In 2014, we mailed a 30-item survey to a national sample of hematologic oncologists randomly selected from the American Society of Hematology clinical directory. The survey was developed through focus groups (n=20) and cognitive debriefing (n=5) with hematologists whose practices focus on patients with blood cancers. In the resulting survey, we provided a list of standard EOL quality measures (Earle, JCO, 2003; Keating, Cancer, 2010; Phelps, JAMA, 2009; see table) and two novel hematology-based measures (no red cell transfusions ≤ 7 days before death, and no platelet transfusions ≤ 7 days before death) and asked "Please indicate whether or not you feel each is an acceptable indicator of good quality EOL care for patients with hematologic malignancies." We decided a priori that we would consider a measure to be "highly acceptable" if there were at least 75% agreement among hematologic oncologists on its acceptability. Worrying that they might reject them all, we also asked them to identify three measures they would choose in a scenario where three had to be adopted. Results: We received 349 surveys from 48 states (response rate: 57.3%). Non-responders were not significantly different across known variables (gender and region of practice). Among respondents, median age was 52 years, median time in practice was 25 years, and 43% practiced primarily in tertiary centers. Eighty-seven percent were board-certified in oncology, 81% in hematology, and 71% in both specialties. The table below shows acceptability of the quality measures as rated by respondents. In the exercise where three measures had to be chosen, the one chosen most often was no CPR within 30 days of death (54%), followed by enrollment in hospice >7 days before death (46%). Conclusions: In contrast to our hypothesis, all of the measures we presented were considered acceptable by a substantial proportion of the hematologic oncologists in our national cohort. Moreover, while four of the measures reached our a priori designation of being highly acceptable, the two hematology-focused measures did not meet this same threshold. These data suggest that in hematologic oncology, resources should be directed towards addressing barriers to performance on established EOL quality measures in addition to creating new ones. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals Billed Palliative Care Services and End-of-Life Care in Patients with Hematologic Malignancies

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 384-384
Author(s):  
Vinay B Rao ◽  
Emmanuelle Belanger ◽  
Pamela C Egan ◽  
Thomas W. LeBlanc ◽  
Adam J Olszewski
Keyword(s):  
Palliative Care ◽  
Board Of Directors ◽  
Research Funding ◽  
Hematologic Malignancies ◽  
Care Quality ◽  
Medicare Beneficiaries ◽  
Advisory Committees ◽  
Care Services ◽  
Palliative Care Services ◽  
Eol Care

Background: Patients with hematologic malignancies often receive aggressive care at the end of life (EOL), leading to lower quality of life. Access to early palliative care may improve EOL care outcomes, its benefits are less well established in hematologic malignancies than in solid tumors. We sought to describe the use of palliative care services among Medicare beneficiaries with hematologic malignancies, and associated EOL quality measures. Methods: Using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare registry, we studied fee-for-service Medicare beneficiaries diagnosed with acute or chronic leukemias, lymphomas, myeloma, myelodysplastic syndrome, or myeloproliferative neoplasms, who died in 2001-2015. We described trends in the use of billed palliative care services (BPCS, identified by codes in clinician encounter claims: ICD-9 V66.7 or ICD-10 Z51.5). Among patients surviving &gt;30 days from diagnosis, we compared baseline characteristics and EOL care quality metrics for patients with and without "early" BPCS (defined as services initiated &gt;30 days before death), as well as Medicare spending in the last 30 days of life. Multivariable models were fitted as appropriate according to outcome variable (robust Poisson, negative binomial, or log-gamma) and adjusting for hematologic malignancy histology, patients' age, sex, race, marital status, Medicaid co-insurance, comorbidity index and performance status indicator (calculated from claims within 1 year before death), and year of death. Results: Among the 139,191 decedents, median age at death was 82 years and 46.4% were women. The proportion with any BPCS was 5.2% overall during the study period, and it increased from 0.4% in 2001 to 13.3% in 2015 (Fig. A). Median time from the first BPCS encounter to death was 10 days (interquartile range, 3 to 39), and it increased from 6 days in 2001 to 12 days in 2015. Most (84.3%) BPCS encounters occurred during hospital admissions (Fig. B), and this proportion did not significantly change over time. Although the number of BPCS claims increased over time for any specialty, there was a relative increase in claims billed by nurse practitioners (from 7.9% in 2001/05, to 29.7% in 2011/15) or palliative care specialists (from 0% to 15.6%, respectively). Use of early BPCS remained rare, but increased from 0.2% in 2001 to 4.3% in 2015. Overall, early BPCS constituted 28.5% of all first BPCS. A relatively higher proportion of early BPCS occurred in the ambulatory setting (15.0%). In the comparative cohort of patients who survived &gt;30 days from diagnosis (N=120,741, Table), the use of early BPCS (1.7% overall) was more frequent in acute leukemia than in other histologies, adjusting for other factors. It was also significantly more frequent among Black patients, those with higher comorbidity indices or poor performance statuses, and those who received active chemotherapy at any point. Presence of early BPCS was associated with significantly improved EOL care quality metrics, including higher rates of hospice use, longer hospice length of stay, and lower use of aggressive measures, like repeated hospitalizations, admissions to the intensive care unit, and receipt of chemotherapy in the last 14 days of life (see Table). Early BPCS were also associated with significantly lower average Medicare spending in the last 30 days of life (marginal means $21,380 with and $23,651 without early BPCS, P&lt;.001). Conclusion: Use of BPCS among Medicare beneficiaries with hematologic malignancies has increased steeply in recent years, but most encounters still occur within days of death in the inpatient setting. This pattern potentially limits the benefits that could be achieved for patients and their caregivers with earlier institution of palliative care. Early BPCS are associated with better EOL care quality metrics similar to those observed in solid tumors, but causation remains uncertain in retrospective claims data, especially given known underutilization of palliative care billing codes in non-terminal patients. Our results support the need for prospective trials of early palliative care for patients with hematologic malignancies, and for research about the barriers to early access to palliative care that may be specific to this patient population. Disclosures LeBlanc: Pfizer Inc: Consultancy; Heron: Membership on an entity's Board of Directors or advisory committees; Daiichi-Sankyo: Membership on an entity's Board of Directors or advisory committees; CareVive: Consultancy; Agios: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Medtronic: Membership on an entity's Board of Directors or advisory committees; Otsuka: Consultancy, Membership on an entity's Board of Directors or advisory committees; Helsinn: Consultancy; Astra Zeneca: Consultancy, Research Funding; Amgen: Membership on an entity's Board of Directors or advisory committees; AbbVie: Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Consultancy, Research Funding; American Cancer Society: Research Funding; Duke University: Research Funding; Jazz Pharmaceuticals: Research Funding; NINR/NIH: Research Funding; Flatiron: Consultancy; Celgene: Honoraria. Olszewski:Genentech: Research Funding; TG Therapeutics: Research Funding; Adaptive Biotechnologies: Research Funding; Spectrum Pharmaceuticals: Research Funding.

scholarly journals Incidence rates and contemporary trends in primary urethral cancer

2021 ◽  
Author(s):  
Mike Wenzel ◽  
Luigi Nocera ◽  
Claudia Collà Ruvolo ◽  
Christoph Würnschimmel ◽  
Zhe Tian ◽  
...  
Keyword(s):  
African Americans ◽  
Incidence Rate ◽  
Incidence Rates ◽  
Regression Analyses ◽  
Histological Subtype ◽  
Annual Percent Change ◽  
Male And Female ◽  
Percent Change ◽  
Log Linear ◽  
Over Time

Abstract Purpose We assessed contemporary incidence rates and trends of primary urethral cancer. Methods We identified urethral cancer patients within Surveillance, Epidemiology and End Results registry (SEER, 2004–2016). Age-standardized incidence rates per 1,000,000 (ASR) were calculated. Log linear regression analyses were used to compute average annual percent change (AAPC). Results From 2004 to 2016, 1907 patients with urethral cancer were diagnosed (ASR 1.69; AAPC: -0.98%, p = 0.3). ASR rates were higher in males than in females (2.70 vs. 0.55), respectively and did not change over the time (both p = 0.3). Highest incidence rates were recorded in respectively ≥75 (0.77), 55–74 (0.71) and ≤54 (0.19) years of age categories, in that order. African Americans exhibited highest incidence rate (3.33) followed by Caucasians (1.72), other race groups (1.57) and Hispanics (1.57), in that order. A significant decrease occurred over time in Hispanics, but not in other race groups. In African Americans, male and female sex-stratified incidence rates were higher than in any other race group. Urothelial histological subtype exhibited highest incidence rate (0.92), followed by squamous cell carcinoma (0.41), adenocarcinoma (0.29) and other histologies (0.20). In stage stratified analyses, T1N0M0 stage exhibited highest incidence rate. However, it decreased over time (−3.00%, p = 0.02) in favor of T1-4N1-2M0 stage (+ 2.11%, p = 0.02). Conclusion Urethral cancer is rare. Its incidence rates are highest in males, elderly patients, African Americans and in urothelial histological subtype. Most urethral cancer cases are T1N0M0, but over time, the incidence of T1N0M0 decreased in favor of T1-4N1-2M0.

scholarly journals At-a-glance - Cancer trends in Canada, 1984 to 2015

2019 ◽  
Vol 39 (11) ◽  
pp. 310-314
Author(s):  
Alain A. Demers ◽  
Darren R. Brenner ◽  
Leah Smith ◽  
Amanda Shaw
Keyword(s):  
Prostate Cancer ◽  
Incidence Rates ◽  
Annual Percent Change ◽  
Cancer Statistics ◽  
Incidence Trends ◽  
Percent Change ◽  
Cancer Types ◽  
Trends Over Time ◽  
Cancer Trends ◽  
Over Time

Examining incidence trends of all cancers combined in order to understand cancer trends can be misleading, as patterns can vary across individual cancer types. This paper highlights findings on trends over time from Canadian Cancer Statistics 2019, as measured by the annual percent change (APC) of age-standardized incidence rates. Among the results were a recent increase in thyroid cancer in males (APC: 6.4%, 1997–2015), as well as decreases in prostate cancer (APC: −9.1%, 2011–2015) and cervical cancer (APC: −3.3%, 2010–2015).

scholarly journals Incidence rates and contemporary trends in primary urethral cancer

2021 ◽  
Author(s):  
Mike Wenzel ◽  
Luigi Nocera ◽  
Claudia Collà Ruvolo ◽  
Christoph Würnschimmel ◽  
Zhe Tian ◽  
...  
Keyword(s):  
African Americans ◽  
Incidence Rate ◽  
Incidence Rates ◽  
Regression Analyses ◽  
Histological Subtype ◽  
Annual Percent Change ◽  
Percent Change ◽  
Log Linear ◽  
Incident Cases ◽  
Over Time

Abstract Purpose: We assessed contemporary incidence rates and trends of primary urethral cancer. Methods: We identified urethral cancer patients within Surveillance, Epidemiology and End Results registry (SEER, 2004–2016). Age-standardized incidence rates per 1,000,000 (ASR) were calculated. Log linear regression analyses were used to compute average annual percent change (AAPC). Results: From 2004–2016, 1,907 patients with urethral cancer were diagnosed (ASR 1.69; AAPC: -0.98%, p = 0.3). ASR rates were higher in males than in females (2.70 vs. 0.55), respectively and did not change over the time (both p = 0.3). Highest incidence rates were recorded in respectively ≥ 75 (0.77), 55–74 (0.71) and ≤ 54 (0.19) years of age categories, in that order. African Americans exhibited highest incidence rate (3.33) followed by Caucasians (1.72), other race groups (1.57) and Hispanics (1.57), in that order. A significant decrease occurred over time in Hispanics, but not in other race groups. In African Americans, male and female sex-stratified incidence rates were higher than in any other race group. Urothelial histological subtype exhibited highest incidence rate (0.92), followed by squamous cell carcinoma (0.41), adenocarcinoma (0.29) and other histologies (0.20). In stage stratified analyses, T1N0M0 stage exhibited highest incidence rate. However, it decreased over time (-3.00%, p = 0.02) in favor of T1 − 4N1 − 2M0 stage (+ 2.11%, p = 0.02). Conclusion: Urethral cancer is rare. Its incidence rates are highest in males, elderly patients, African Americans and in urothelial histological subtype. Most incident cases are T1N0M0, but over time, the incidence of T1N0M0 decreased in favor of T1 − 4N1 − 2M0.

scholarly journals Cancer mortality trends in Brazilian adults aged 80 and over from 2000 to 2017

2020 ◽  
Vol 14 (4) ◽  
pp. 274-281
Author(s):  
João Pedro Rufino ◽  
Ana Laura Maciel Monteiro ◽  
Julia Português Almeida ◽  
Karolina Moreira dos Santos ◽  
Mariana da Cruz Andrade ◽  
...  
Keyword(s):  
Cancer Mortality ◽  
Oldest Old ◽  
Mortality Rates ◽  
Cancer Site ◽  
80 And Over ◽  
Mortality Trends ◽  
Aged 80 And Over ◽  
Annual Percent Change ◽  
Percent Change ◽  
Over Time

INTRODUCTION: Adults aged 80 and over represent the fastest growing segment of the population in emerging countries. Studies of cancer mortality trends in the oldest old population are scarce in Brazil. OBJECTIVE: To describe trends in cancer mortality in the Brazilian oldest old, by gender and cancer type, from 2000 to 2017. METHODS: This was a descriptive study with a time trend design, based on data from the Mortality Information System (of the Informatics Department of the Unified Health System). The variables analyzed were year of death, sex and cancer site. The five most common types of cancer were identified, and mortality rates and trends were calculated for each one. Trends were determined using joinpoint regression. In all cases where one or more joinpoints were statistically significant, the average annual percent change (AAPC) was calculated based on the arithmetic mean of the annual percent change (APC), weighted by the length of each segment. The statistical significance of the APC and AAPC was estimated by calculating 95% confidence intervals (CI) with an alpha level of 0.05. RESULTS: Mortality rates increased over time (AAPC = 1.50; 95%CI, 1.20 – 1.70) in both males (AAPC = 1.90; 95%CI, 1.70 – 2.10) and females (AAPC = 1.30; 95%CI, 1.00 – 1.50). Men had higher mortality rates than women. The most common causes of cancer-related death were prostate cancer (AAPC = 1.70; 95%CI, 1.10 – 2.30) in men, and breast cancer (AAPC = 1.90; 95%CI, 1.50 – 2.20) in women, followed by cancers of the lung and bronchus, stomach and colon. All rates increased over time, except in the case of stomach cancer. CONCLUSION: The study revealed increasing mortality rates for screenable and/or preventable cancers, alerting to the need for preventive measures.

Billed palliative care services and end-of-life care in patients with hematologic malignancies.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 43-43
Author(s):  
Vinay Rao ◽  
Adam J. Olszewski ◽  
Pamela Egan ◽  
Thomas William LeBlanc ◽  
Emmanuelle Belanger
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Solid Tumors ◽  
Hospital Admissions ◽  
Myeloproliferative Neoplasm ◽  
Hematologic Malignancies ◽  
Quality Metrics ◽  
Care Quality ◽  
Medicare Beneficiaries ◽  
Eol Care

43 Background: Patients (pts) with hematologic malignancies (HMs) often receive aggressive care at the end of life (EOL), leading to lower quality of life. Early palliative care (PC) may improve EOL care, but its benefits are less established in HMs than in solid tumors. We sought to describe the use of billed PC services (BPCS) among Medicare beneficiaries with HMs and associated EOL quality measures. Methods: Using the linked SEER-Medicare registry, we studied Medicare beneficiaries diagnosed with leukemia, lymphoma, myeloma, myelodysplastic syndrome, or myeloproliferative neoplasm who died from 2001-2015. We described trends in the use of BPCS (identified by codes in clinician encounter claims). Among pts surviving >30 days from diagnosis, we compared baseline characteristics and EOL care quality metrics for pts with and without “early BPCS” (initiated >30 days before death). Results: The proportion of pts ( N=139,191, median age 81 years) with any BPCS increased from 0.4% in 2001 to 13.3% in 2015. Median time from first BPCS encounter to death was 10 days and 84.3% occurred during hospital admissions. Use of early BPCS was rare (from 0.2% in 2001 to 4.3% in 2015, with 28% of all first BPCS occurring early) and more frequent in acute leukemia, among black pts, those with higher comorbidity indices or poor performance statuses, and those receiving chemotherapy. Receipt of early BPCS was associated with improved EOL care quality metrics (see Table). Conclusions: Use of BPCS among Medicare beneficiaries with HMs has steeply increased in recent years, but most encounters still occur within days of death. Early BPCS are associated with better EOL care quality metrics similar to those observed in solid tumors. Our results support the need for prospective trials of early PC for pts with HMs. [Table: see text]

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