This proposal is submitted for a first award (R29). In recent years, the way that people die in the U.S. has attracted growing public concern. As suffering cancer patients increasingly request assistance to end their lives, some argue that too little attention is paid to the quality of life in the final months. Voters in some states have sponsored referenda on the right to end one's own life when gravely ill, although the 1997 Supreme Court ruled against the right to a physician-assisted suicide. Nonetheless, those continuing to lead public calls for more individual control over the dying process have frequently been cancer patients who describe uncontrollable pain or other intolerable symptoms. Relatively little is known about the quality of the dying experience for cancer patients, especially from the patient's perspective, or about patterns of care used during the final months of life. The overall goal of this study is to describe the dying experience of cancer patients, focusing on specific types of care, the resources consumed, and whether that care complies with a patient s preferences. The project will use two complimentary databases to achieve this goal: 1. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT) database, and 2. The Surveillance, Epidemiology, and End Results (SEER) program database. Both databases have been merged with Medicare claims data for patients older than 65 years. The proposed study will be conducted in four overlapping phases, each with its own specific aims. Phase one will describe the dying experience of the seriously ill lung and colon cancer patients, including preferences for care. Phase two will describe patterns of care for cancer patients at the end of life. Phase three will examine the nature and intensity of care received at the end of life. Phase four will describe variations in end-of-life cancer care across place and time. This study will provide an in-depth description of the quality of the dying experience for selected cancer patients, and a better understanding of where cancer patients receive care during their last six months of life, the intensity of nature of their care, and whether patients' preferences for care are being respected. Information obtained from the study can be used to improve the quality of care for patients at the end of life and help to determine the nature and amount of resources that might be required to meet patients' needs.
| Ngo-Metzger, Quyen; Phillips, Russell S; McCarthy, Ellen P (2008) Ethnic disparities in hospice use among Asian-American and Pacific Islander patients dying with cancer. J Am Geriatr Soc 56:139-44 |
| Sabatino, Susan A; Burns, Risa B; Davis, Roger B et al. (2006) Breast cancer risk and provider recommendation for mammography among recently unscreened women in the United States. J Gen Intern Med 21:285-91 |
| Goel, Mita Sanghavi; Burns, Risa B; Phillips, Russell S et al. (2005) Trends in breast conserving surgery among Asian Americans and Pacific Islanders, 1992-2000. J Gen Intern Med 20:604-11 |
| Wee, Christina C; Phillips, Russell S; McCarthy, Ellen P (2005) BMI and cervical cancer screening among white, African-American, and Hispanic women in the United States. Obes Res 13:1275-80 |
| Wee, Christina C; McCarthy, Ellen P; Phillips, Russell S (2005) Factors associated with colon cancer screening: the role of patient factors and physician counseling. Prev Med 41:23-9 |
| Goel, Mita Sanghavi; McCarthy, Ellen P; Phillips, Russell S et al. (2004) Obesity among US immigrant subgroups by duration of residence. JAMA 292:2860-7 |
| Wee, Christina C; McCarthy, Ellen P; Davis, Roger B et al. (2004) Obesity and breast cancer screening. J Gen Intern Med 19:324-31 |
| McCarthy, Ellen P; Burns, Risa B; Ngo-Metzger, Quyen et al. (2003) Hospice use among Medicare managed care and fee-for-service patients dying with cancer. JAMA 289:2238-45 |
| Goel, Mita Sanghavi; Wee, Christina C; McCarthy, Ellen P et al. (2003) Racial and ethnic disparities in cancer screening: the importance of foreign birth as a barrier to care. J Gen Intern Med 18:1028-35 |
| Cintron, Alexie; Hamel, Mary B; Davis, Roger B et al. (2003) Hospitalization of hospice patients with cancer. J Palliat Med 6:757-68 |
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