• Cara L McDermott, Aasthaa Bansal, Scott D Ramsey, Gary H Lyman, and Sean D Sullivan.
• Cambia Palliative Care Center of Excellence Department of Medicine, University of Washington, Seattle, Washington, USA; Hutchinson Institute for Cancer Outcomes Research Fred Hutchinson Cancer Research Center, Seattle, Washington, USA. Electronic address: clm2@uw.edu.
• J Pain Symptom Manage. 2018 Nov 1; 56 (5): 699708.e1699-708.e1.

ContextLimited data exist regarding how depression diagnosed at different times relative to a cancer diagnosis may affect healthcare utilization at end of life (EOL).ObjectivesTo assess the relationship between depression and health care utilization at EOL among older adults (ages >=67) diagnosed with advanced non-small cell lung cancer (NSCLC) from 2009 to 2011.MethodsUsing the SEER-Medicare database, we fit multivariable logistic regression models to explore the association of depression with duration of hospice stay plus high-intensity care, for example inpatient admissions, in-hospital death, emergency department visits, and chemotherapy at EOL. We used a regression model to evaluate hospice enrollment, accounting for the competing risk of death.ResultsAmong 13,827 subjects, pre-cancer depression was associated with hospice enrollment (sub-hazard ratio 1.19, 95% confidence interval [CI] 1.11-1.28), 90 + hospice days (adjusted odds ratio [aOR] 1.29, 95% CI 1.06-1.58), and lower odds of most utilization; we found no association with EOL chemotherapy. Diagnosis-time depression was associated with hospice enrollment (SHR 1.16, 95% CI 1.05-1.29) but not high-intensity utilization. Post-diagnosis depression was associated with lower hospice enrollment (SHR 0.80, 95% CI 0.74-0.85) and higher odds of ICU admission (aOR 1.18, 95% CI 1.01-1.37).ConclusionEOL healthcare utilization varied by timing of depression diagnosis. Those with pre-cancer depression had lower odds of high-intensity healthcare, were more likely to utilize hospice, and have longer hospice stays. Regular depression screening and treatment may help patients optimize decision-making for EOL care. Additionally, hospice providers may need additional resources to attend to mental health needs in this population.Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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