Regional Variation in Spending and Survival for Older Adults With Advanced Cancer

Gabriel Brooks MD Fellow, Medical Oncology Dana-Farber Cancer Interview with Gabriel Brooks MD
Fellow, Medical Oncology
Dana-Farber Cancer Institute What are the main findings of the study?

Dr. Brooks: First, we found that there is substantial regional variation in Medicare spending for patients with advanced cancer.  For patients with a new diagnosis of advanced stage cancer, spending in the six months following diagnosis varied by 32% between regions in the highest and lowest quintiles of spending.  And for patients who died from cancer, spending in the last six months of life varied by 41% between the highest and lowest spending regions.

Second, we tested the association between area-level spending and survival from the time of advanced cancer diagnosis.  We found that there was no consistent association between increasing spending and survival for any of the five cancer sites included in our study (non-small cell lung cancer, colorectal cancer, pancreas cancer, breast cancer and prostate cancer). Were any of the findings unexpected?

Dr. Brooks: Although increasing area-level spending was not associated with longer advanced cancer survival, we found that patients in high-spending areas had more hospitalizations, more ICU admissions and lower rates of hospice utilization than patients in low-spending areas.   Interestingly, there was very little variation in the proportion of patients who received at least some chemotherapy treatment, suggesting that oncologists’ approach to chemotherapy use is relatively consistent across geographic regions. What should clinicians and patients take away from your report?

Dr. Brooks:  In my interpretation of our findings, the main takeaway is that regions where high-intensity practice patterns are the norm do not achieve superior survival results for patients with advanced cancer.   This finding is consistent with other recent research studies which have demonstrated the benefits of hospice and proactive symptom management in patients with advanced cancer.  I believe that patients deserve high-quality care at all phases of their battle with cancer, but our findings reiterate the message that high-quality care often means symptom-directed outpatient care rather than hospitalization and other aggressive measures at the end of life. What recommendations do you have for future research as a result of this study?

Dr. Brooks: We are interested in learning more about the specific reasons for hospitalization in patients with cancer.  It is conceivable that many hospitalizations in patients with advanced cancer could be avoided by better coordination of outpatient cancer care between patients, families, oncologists and palliative care providers.  We are also planning research to further investigate the specific health care services that are the drivers of regional variation in advanced cancer care.


Regional Variation in Spending and Survival for Older Adults With Advanced Cancer
JNCI J Natl Cancer Inst first published online March 12, 2013 doi:10.1093/jnci/djt025

Gabriel A. Brooks, Ling Li, Dhruv B. Sharma, C. Weeks, Michael J. Hassett,
K. Robin Yabroff, and Deborah Schrag

Last Updated on March 25, 2014 by Marie Benz MD FAAD