Originally published as JCO Early Release 10.1200/JCO.2008.16.3956 on November 10 2008

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Setoguchi, S. Articles by Haas, J. S. Search for Related Content PubMed PubMed Citation Articles by Setoguchi, S. Articles by Haas, J. S. Related Articles Related Editorial Social Bookmarking                            What's this?

Comparison of Prospective and Retrospective Indicators of the Quality of End-of-Life Cancer Care

Soko Setoguchi, Craig C. Earle, Robert Glynn, Margaret Stedman, Jennifer M. Polinski, Colleen P. Corcoran, Jennifer S. Haas

From the Division of Pharmacoepidemiology, Department of Medicine; and Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA

Corresponding author: Jennifer Haas, MD, Division of General Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont St, Boston, MA 02120-1613; e-mail: jhaas{at}partners.org

Purpose To compare prospectively and retrospectively defined benchmarks for the quality of end-of-life care, including a novel indicator for the use of opiate analgesia.

Methods Linked claims and cancer registry data from 1994 to 2003 for New Jersey and Pennsylvania were used to examine prospective and retrospective benchmarks for seniors with breast, colorectal, lung, or prostate cancer who participated in state pharmaceutical benefit programs.

Results Use of opiates, particularly long-acting opiates, was low in both the prospective and retrospective cohorts (9.1% and 10.1%, respectively), which supported the underuse of palliative care at the end-of-life. Although hospice was used more commonly in the retrospective versus prospective cohort, admission to hospice within 3 days of death was similar in both cohorts (28.8% v 26.4%), as was the rate of death in an acute care hospital. Retrospective and prospective measures identified similar physician and hospital patterns of end-of-life care. In multivariate models, a visit with an oncologist was positively associated with the use of chemotherapy, opiates, and hospice. Patients who were cared for by oncologists in small group practices were more likely to receive chemotherapy (retrospective only) and less likely to receive hospice (both) than those in large groups. Compared with patients who were cared for in teaching hospitals, those in other hospitals were more likely to receive chemotherapy (both) and to have toxicity (prospective) but were less likely to receive opiates (both) and hospice (retrospective).

Conclusion Retrospective and prospective measures, including a new measure of the use of opiate analgesia, identify some similar physician and hospital patterns of end-of-life care.

published online ahead of print at www.jco.org on November 10, 2008

Supported by the Agency for Healthcare Research and Quality Contract No. 290-20-050016, with an interagency agreement from the National Cancer Institute, and by the US Department of Health and Human Services as part of the Developing Evidence to Inform Decisions About Effectiveness program.

Disclaimer: The authors of this manuscript are responsible for its content. Statements in the manuscript should not be construed as endorsements by the Agency for Healthcare Research and Quality, the National Cancer Institute, or the US Department of Health and Human Services.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Editorial

• Promoting Efficiency and Quality of Care in the Hummer Health Care System
  Karl A. Lorenz
  JCO 2008 26: 5664-5665 [Full Text]

This article has been cited by other articles:

				S. T. Tang, S.-C. Wu, Y.-N. Hung, J.-S. Chen, E.-W. Huang, and T.-W. Liu Determinants of Aggressive End-of-Life Care for Taiwanese Cancer Decedents, 2001 to 2006 J. Clin. Oncol., September 20, 2009; 27(27): 4613 - 4618. [Abstract] [Full Text] [PDF]

				K. A. Lorenz Promoting Efficiency and Quality of Care in the Hummer Health Care System J. Clin. Oncol., December 10, 2008; 26(35): 5664 - 5665. [Full Text] [PDF]