End-of-life hospital costs in cancer patients: do advance directives or routes of hospital admission make a difference?

OBJECTIVE: End-of-life cancer care is costly. The current study explored whether advance directives or route of hospital admission reduced cancer patients' terminal hospitalization costs. METHODS: This single-institution study focused on solid tumor patients who died on an inpatient oncology service in 2008 and 2009. Patients' total costs were compared based on advance directives and route of hospitalization. RESULTS: Among 120 patients, all except 4 had an incurable malignancy. Forty-six (38%) had an advance directive. Sixteen (13%) were admitted after an oncology clinic visit and 6 (5%) from hospice; others were admitted via other routes, most commonly from the emergency department. The median total cost for hospitalization (range) per patient was USD 12,962 (1,244-138,877). Patients with advance directives had no statistically significant difference in cost (p = 0.30), even after adjusting for age and time in the hospital. Those admitted after an oncology clinic or from hospice also had no difference in cost compared to those admitted via another route. Use of cardiopulmonary resuscitation, intensive care unit monitoring and intubation were similar between all compared groups. CONCLUSION: Advance directives and route of admission do not appear to impact the cost of terminal hospitalization for cancer patients.

If you hold it off-hours, will they come? Results from a feasibility project intended to stimulate interest in the physician-investigator career path among medical oncology trainees.

BACKGROUND: An "endangered species," the physician-scientist faces challenges in oncology. The authors thus implemented a series of voluntary off-hours sessions on academic development for their trainees. METHODS: Numerous workday interruptions among trainees led the authors to conclude that off-hours sessions would be preferable. Thus, this feasibility project was conducted. All 34 trainees were invited to a session and were surveyed thereafter. An attendance rate of >or=34% was to be a "success." RESULTS: Seventy percent of trainees attended, and over 90% said they would do so again. Write-in comments were mostly favorable. CONCLUSIONS: Off-hours sessions to discuss academic career development are feasible among medical oncology trainees.

An update on advance directives in the medical record: findings from 1186 consecutive patients with unresectable exocrine pancreas cancer.

BACKGROUND: The Terri Schiavo case and other recent events underscore the importance of advance directives. Yet, in the past, only a small subgroup has utilized them. This study from a large tertiary medical center was undertaken to assess current rates of advance directives among patients with incurable pancreas cancer. METHODS/RESULTS: The medical records of 1,186 consecutive patients with unresectable pancreas cancer were reviewed over a 4-year span. Only 174 patients (15%) had an advance directive in the medical record. Older age and having cancer therapy at our institution were associated with a greater likelihood of having an advance directive with odds ratios (95% confidence intervals) of 8.26 (2.81, 24.93) and 2.86 (2.03, 4.02), respectively, in multivariate analyses. Importantly, 42 patients (24%) had a different person designated as their healthcare agent in their advanced directive than what appeared in the medical record as the "contact person." CONCLUSION: These findings underscore the ongoing need to discuss advance directives with patients with incurable malignancies and to clarify patients' wishes when seemingly contradictory information appears in other parts of the medical record.