Analysis of a National Database to Evaluate Place-of-Death Preferences Among Patients With Bladder Cancer in the United States of America From 2003 to 2020

Document Type

Conference Proceeding

Publication Date

2-1-2024

Publication Title

Journal of Clinical Oncology

Abstract

Background: Bladder Cancer (BC) is associated with significant treatment related morbidity and mortality risk. End of life care (EOL) and advance care planning are crucial in oncology care of BC patients. Place of Death (PoD) is an important determinant of patient and caregiver preference, access to home-based supportive care, and cost of caregiving at EOL. We evaluate trends in PoD for patients and hospice utilization with BC in the U.S. from 2003 to 2020 based on the CDC WONDER (Centers for Disease Control and Prevention for Wide-ranging Online Data for Epidemiologic Research) database. Methods: We analyzed data using the CDC WONDER database from January 01, 2003, to December 31, 2020. The data for deaths due to bladder cancer was pooled using the International Classification of Diseases-10th (ICD-10) Revision code as C67, C67.1, C67.2, C67.3, C67.4, C67.5, C67.8, C67.9. The inclusion criteria included patients aged .18. The demographic data was obtained to calculate descriptive statistics using age, gender, PoD, census region, and utilization of hospice mortality accordingly over the past two decades. Results: The analysis demonstrated that overall mortality due to BC were 319,229 from 2003-2020. Of these deaths, 27,990 (8.8%) were recorded in hospice facilities. The hospice mortality has steadily increased from 0.3% in 2003 to the highest of 9.10% in 2019, with a sharp decline to 7.3% in 2020. We noticed the PoD differed based on racial subgroups. More than half of African American (AA) population mortality was observed in a medical facility (57.01%) compared to Whites (50.27%). Hospice or death at home in AA were (42.99%) compared to whites (49.73%). Age stratified mortality analysis showed decreased hospice utilization in 25- 44 yrs (9.61%) vs 65+ yrs (10.15%). Stratifying the results by the state census showed highest hospice utilization in Florida (25.23%) vs the lowest in Virginia (2.51%). Conclusions: To our knowledge this is the first study utilizing CDC WONDER database to demonstrate PoD preferences in BC related deaths. We observed a steady increase in hospice utilization from 2003- 2020 throughout the US with a decline in 2020 possibly related to COVID pandemic. AA had higher mortality in medical facilities compared to whites, whereas the white population has utilized more hospice services or died at home. This study highlights the need for further efforts and policy changes needed to improve hospice utilization across the US with a focus on improved access to EOL care in BC patients

Volume

42

Issue

4 Suppl

First Page

580

Comments

2024 ASCO (American Society of Clinical Oncology) Genitourinary Cancers Symposium, January 25-27, 2024, San Francisco, CA

DOI

10.1200/JCO.2024.42.4_suppl.580

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