• Yuhua Bao, Renee C Maciejewski, Melissa M Garrido, Manish A Shah, Paul K Maciejewski, and Holly G Prigerson.
• Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York, USA; Department of Psychiatry, Weill Cornell Medical College, New York, New York, USA. Electronic address: yub2003@med.cornell.edu.
• J Pain Symptom Manage. 2018 Apr 1; 55 (4): 1113-1121.e3.

ContextFor patients with metastatic cancer and limited life expectancy, potential benefits of chemotherapy must be balanced against harms to quality of life near death and increased out-of-pocket costs of care.ObjectivesTo evaluate the association between chemotherapy use by patients with Stage IV pancreatic cancer and health care use and Medicare and out-of-pocket costs in the last 30 days of life.MethodsWe conducted a retrospective cohort study of 3825 patients aged 66 years or older when diagnosed with Stage IV pancreatic cancer in 2006-2011, using the linked Surveillance, Epidemiology, and End Results-Medicare data. Using a propensity score matched sample, we examined associations between initiation of chemotherapy shortly after the metastatic diagnosis (and secondarily, continued chemotherapy use in the last 30 days of life) and health care use and costs (both Medicare payment and patient out-of-pocket costs) in the last 30 days of life.ResultsChemotherapy use was associated with increased rates of hospital admissions (45.0% vs. 29.2%, P < 0.001), emergency department visits (41.3% vs. 27.2%, P < 0.001), and death in a hospital (14.2% vs. 9.1%, P < 0.001); fewer days in hospice care (11.5 days vs. 15.7 days, P < 0.001); and more than 50% increase in patient out-of-pocket costs for care ($1311.5 vs. $841.0, P < 0.001) in the last 30 days of life. Among patients who initiated chemotherapy, more stark differences in these outcomes were found by whether patients received chemotherapy in the last 30 days of life.ConclusionChemotherapy use among older patients diagnosed with metastatic pancreatic cancer was associated with substantially increased use of health care and higher patient out-of-pocket costs near death.Copyright © 2017 American Academy of Hospice and Palliative Medicine. All rights reserved.

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