Patterns of care and costs for older patients with colorectal cancer at the end of life: Descriptive study of the United States and Canada

Karen E. Bremner*, K. Robin Yabroff, Diarmuid Coughlan, Ning Liu, Christopher Zeruto, Joan L. Warren, Claire de Oliveira, Angela B. Mariotto, Clara Lam, Michael J. Barrett, Kelvin K.W. Chan, Jeffrey S. Hoch, Murray D. Krahn

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


PURPOSE End-of-life (EOL) cancer care is costly, with challenges regarding intensity and place of care. We described EOL care and costs for patients with colorectal cancer (CRC) in the United States and the province of Ontario, Canada, to inform better care delivery. METHODS Patients diagnosed with CRC from 2007 to 2013, who died of any cancer from 2007 to 2013 at age $ 66 years, were selected from the US SEER cancer registries linked to Medicare claims (n = 16,565) and the Ontario Cancer Registry linked to administrative health data (n = 6,587). We estimated total and resource-specific costs (2015 US dollars) from public payer perspectives over the last 360 days of life by 30-day periods, by stage at diagnosis (0-II, III, IV). RESULTS In all months, especially 30 days before death, higher percentages of SEER-Medicare than Ontario patients received chemotherapy (15.7% v 8.0%), and imaging tests (39.4% v 31.1%). A higher percentage of Ontario patients were hospitalized (62.5% v 51.0%), but 43.2% of hospitalized SEER-Medicare patients had intensive care unit (ICU) admissions versus 17.9% of hospitalized Ontario patients. Cost differences between cohorts were greater for patients with stage IV disease. In the last 30 days, mean total costs for patients with stage IV disease were $15,881 (SEER-Medicare) and $12,034 (Ontario) versus $19,354 and $17,312 for stage 0-II. Hospitalization costs were higher for SEER-Medicare patients ($11,180 v $9,434), with lower daily hospital costs in Ontario ($1,067 v $2,004). CONCLUSION These findings suggest opportunities for reducing chemotherapy and ICU use in the United States and hospitalizations in Ontario.

Original languageEnglish
Pages (from-to)E1-E18
JournalJournal of Oncology Practice
Issue number1
Early online date24 Oct 2019
Publication statusPublished - 2020

Bibliographical note

Funding Information:
The Ontario arm of the study was supported by the Canadian Centre for Applied Research in Cancer Control (ARCC). ARCC receives core funding from the Canadian Cancer Society Research Institute Grant No. 2015-703549. The analysis in Ontario was supported by the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care.

Publisher Copyright:
Copyright © 2020 American Society of Clinical Oncology. All rights reserved.

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