The DOI matches its Crossref record; 54 of the 54 references it cites were found in a registry or an index.
Associations Among End-of-Life Discussions, Health-Care Utilization, and Costs in Persons With Advanced Cancer: A Systematic Review
Open accessAbstract
Background: Aggressive end-of-life (EOL) care is associated with lower quality of life and greater regret about treatment decisions. Higher EOL costs are also associated with lower quality EOL care. Advance care planning and goals-of-care conversations (“EOL discussions”) may influence EOL health-care utilization and costs among persons with cancer. Objective: To describe associations among EOL discussions, health-care utilization and place of death, and costs in persons with advanced cancer and explore variation in study measures. Methods: A systematic review was conducted using PubMed, Embase, and CINAHL. Twenty quantitative studies published between January 2012 and January 2019 were included. Results: End-of-life discussions are associated with lower health-care costs in the last 30 days of life (median US$1048 vs US$23482; P < .001); lower likelihood of acute care at EOL (odds ratio [(OR] ranging 0.43-0.69); lower likelihood of intensive care at EOL (ORs ranging 0.26-0.68); lower odds of chemotherapy near death (ORs 0.41, 0.57); lower odds of emergency department use and shorter length of hospital stay; greater use of hospice (ORs ranging 1.79 to 6.88); and greater likelihood of death outside the hospital. Earlier EOL discussions (30+ days before death) are more strongly associated with less aggressive care outcomes than conversations occurring near death. Conclusions: End-of-life discussions are associated with less aggressive, less costly EOL care. Clinicians should initiate these discussions with patients having cancer earlier to better align care with preferences.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Advance care planning has been associated with earlier and increased use of hospice care [12–15], reduced intensive treatment and hospitalizations at the end of life [13, 15–18], and better quality of life in patients with cancer and caregivers [12, 19].”
From Mindfulness to enhance quality of life and support advance care planning: a pilot randomized controlled trial for adults with advanced cancer and their family caregivers. (2024) · cites this paper as [13]
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & for the PRISMA Group (2009) · BMJ · doi:10.1136/bmj.b2535 · Cited by 83,823
Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2010) · International Journal of Surgery · doi:10.1016/j.ijsu.2010.02.007 · Cited by 12,156 · cited 2×
“The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations.(49) Two authors independently rated the quality of evidence using the Oxford Centre for Evidence-Based Medicine grading guide.”
FERRELL, B. R., Temel, J. S., Temin, S., Alesi, E. R., Balboni, T. A., Basch, E., Firn, J. I., Paice, J. A., Peppercorn, J. M., Phillips, T., et al. (2017) · Journal of Clinical Oncology · doi:10.1200/jco.2016.70.1474 · Cited by 2,148 · cited 1×
“To better align care with preferences, the National Academy of Medicine and American Society of Clinical Oncology recommend patients and providers have goals-of-care (GOC) conversations(16) and that palliative care, which typically involves such discussions,(15) be integrated into standard oncology care.(17) 1 NewCour…”
Communication About Serious Illness Care Goals: A Review and Synthesis of Best Practices
Bernacki, R. E., & Block, S. D. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.5271 · Cited by 1,422
Zafar, S. Y., Peppercorn, J. M., Schrag, D., Taylor, D. H., Goetzinger, A. M., Zhong, X., & Abernethy, A. P. (2013) · The Oncologist · doi:10.1634/theoncologist.2012-0279 · Cited by 1,134
Health Care Costs in the Last Week of Life: Associations With End-of-Life Conversations
Zhang, B., Wright, A. A., Huskamp, H. A., Nilsson, M. E., Maciejewski, M. L., Earle, C. C., Block, S. D., Maciejewski, P. K., & Prigerson, H. G. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2008.587 · Cited by 898
Dying in America: improving quality and honoring individual preferences near the end of life
(2015) · Choice Reviews Online · doi:10.5860/choice.191895 · Cited by 879
Efficacy of advance care planning: a systematic review and meta-analysis.
Houben, C. H. M., Spruit, M. A., Groenen, M. T. J., Wouters, E. F. M., & Janssen, D. J. A. (2014) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2014.01.008 · Cited by 765 · cited 1×
“Interventions that include communication about ACP and care preferences have been found to improve concordance between care preferences and actual care delivered.(19) Given that the costs of cancer care may vary by diagnosis, stage of disease, and treatment options(20) and that cancer disproportionately burdens racial…”
Ramsey, S., Blough, D., Kirchhoff, A., Kreizenbeck, K., Fedorenko, C., Snell, K., Newcomb, P., Hollingworth, W., & Overstreet, K. (2013) · Health Affairs · doi:10.1377/hlthaff.2012.1263 · Cited by 699
Mack, J. W., Cronin, A., Keating, N. L., Taback, N., Huskamp, H. A., Malin, J. L., Earle, C. C., & Weeks, J. C. (2012) · Journal of Clinical Oncology · doi:10.1200/jco.2012.43.6055 · Cited by 560 · cited 5×
“One study was a retrospective analysis of a randomized clinical trial (RCT)(43); 1 study was nonrandomized, intervention-based(45); and 18 studies were observational.(1,23,31-42,46-48,51) Strengths of the studies included clearly stated objectives and inclusion criteria, sample sizes adequate for meeting objectives, a…”
InfluentialOverview of Systematic Reviews of Advance Care Planning: Summary of Evidence and Global Lessons
Jiménez, G., Tan, W. S., Virk, A., Low, C. K., Car, J., & Ho, A. H. Y. (2018) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2018.05.016 · Cited by 553
Financial toxicity, Part I: a new name for a growing problem.
Zafar, S. Y., & Abernethy, A. P. (2013) · PubMed · Cited by 499
A Systematic Review of Financial Toxicity Among Cancer Survivors: We Can’t Pay the Co-Pay
Gordon, L. G., Merollini, K. M. D., Lowe, A., & Chan, R. J. (2016) · Patient · doi:10.1007/s40271-016-0204-x · Cited by 480
Quality of End-of-Life Care Provided to Patients With Different Serious Illnesses
Wachterman, M. W., Pilver, C. E., Smith, D., Ersek, M. T., Lipsitz, S. R., & Keating, N. L. (2016) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2016.1200 · Cited by 342
Factors Important to Patients' Quality of Life at the End of Life
Zhang, B., Nilsson, M. E., & Prigerson, H. G. (2012) · Archives of Internal Medicine · doi:10.1001/archinternmed.2012.2364 · Cited by 313
Obermeyer, Z., Makar, M., Abujaber, S., Dominici, F., Block, S. D., & Cutler, D. (2014) · JAMA · doi:10.1001/jama.2014.14950 · Cited by 281
Hoerger, M. P., Greer, J. A., Jackson, V. A., Park, E. R., Pirl, W. F., El-Jawahri, A. R., Gallagher, E. R., Thomas, T. H., Jacobsen, J. C., Perry, L. M., et al. (2018) · Journal of Clinical Oncology · doi:10.1200/jco.2017.75.6676 · Cited by 275 · cited 5×
“Despite variations in discussion comparators, we found each study in the review identified some, if not many, significant associations between EOL discussion and either lower costs near EOL,(36,37,43) lower utilization of high-cost care such as acute or intensive care,(1,31,32,34,39,40,43,46-48) or reduced use or dura…”
InfluentialRacial Disparities in the Outcomes of Communication on Medical Care Received Near Death
Mack, J. W., Paulk, M. E., Viswanath, K., & Prigerson, H. G. (2010) · Archives of Internal Medicine · doi:10.1001/archinternmed.2010.322 · Cited by 270
Smith, A. K., McCarthy, E. P., Paulk, E., Balboni, T. A., Maciejewski, P. K., Block, S. D., & Prigerson, H. G. (2008) · Journal of Clinical Oncology · doi:10.1200/jco.2007.14.8452 · Cited by 267
Health Care Costs for Patients With Cancer at the End of Life
Chastek, B. J., Harley, C., Kallich, J. D., Newcomer, L. N., Paoli, C. J., & Teitelbaum, A. H. (2012) · Journal of Oncology Practice · doi:10.1200/jop.2011.000469 · Cited by 259
Sharp, L., Carsin, A., & Timmons, A. (2012) · Psycho-Oncology · doi:10.1002/pon.3055 · Cited by 258
Weathers, E., O’Caoimh, R., Cornally, N., Fitzgerald, C., Kearns, T., Coffey, A., Daly, E., O’Sullivan, R., McGlade, C., & Molloy, D. W. (2016) · Maturitas · doi:10.1016/j.maturitas.2016.06.016 · Cited by 212
True, G., Phipps, E., Braitman, L. E., Harralson, T. L., Harris, D., & Tester, W. J. (2005) · Annals of Behavioral Medicine · doi:10.1207/s15324796abm3002_10 · Cited by 202
Klingler, C., in der Schmitten, J., & Marckmann, G. (2016) · Palliative Medicine · doi:10.1177/0269216315601346 · Cited by 201 · cited 1×
“Evidence suggests patient–provider discussions about EOL preferences are associated with less aggressive treatment near death(6,22,23) and that interventions involving GOC discussions may reduce costs.(24,25) Cancer is the second leading cause of mortality in the United States and globally(26,27) and one of the most e…”
The financial burden of cancer: estimates from a study of insured women with breast cancer.
Arozullah, A. M., Calhoun, E. A., Wolf, M., Finley, D. K., Fitzner, K. A., Heckinger, E. A., Gorby, N. S., Schumock, G. T., & Bennett, C. L. (2004) · PubMed · Cited by 183
Impact of aggressive management and palliative care on cancer costs in the final month of life
Cheung, M. C., Earle, C. C., Rangrej, J., Ho, T. H., Liu, N., Barbera, L. C., Saskin, R., Porter, J., Seung, S. J., & Mittmann, N. (2015) · Cancer · doi:10.1002/cncr.29485 · Cited by 179
Sharma, R. K., Prigerson, H. G., Penedo, F. J., & Maciejewski, P. K. (2015) · Cancer · doi:10.1002/cncr.29417 · Cited by 134
The utility of cost discussions between patients with cancer and oncologists.
Zafar, S. Y., Chino, F. L., Ubel, P. A., Rushing, C. N., Samsa, G. P., Altomare, I. P., Nicolla, J., Schrag, D., Tulsky, J. A., Abernethy, A. P., et al. (2015) · PubMed · Cited by 128
Quality of Life and Cost of Care at the End of Life: The Role of Advance Directives
Garrido, M. M., Balboni, T. A., Maciejewski, P. K., Bao, Y., & Prigerson, H. G. (2015) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2014.09.015 · Cited by 126 · cited 5×
“Patients who complete ADs may be more likely to prefer less intensive EOL care,36 but Cappell and colleagues (n ¼ 422) found similar odds: Patients with an AD were similarly less likely to receive ICU care within 30 days of death (25% vs 40%, OR ¼ 0.49, P ¼ .001) than patients without ADs.33 Studies did not consistent…”
InfluentialEnd-of-Life Care Matters: Palliative Cancer Care Results in Better Care and Lower Costs
Dalal, S., & Bruera, E. D. (2017) · The Oncologist · doi:10.1634/theoncologist.2016-0277 · Cited by 118
Patel, M. I., H, V. S. M. P., Desai, M., Periyakoil, V. S., Kahn, J. S., Bhattacharya, J., Asch, S. M., Milstein, A. S., & Bundorf, M. K. (2018) · JAMA Oncology · doi:10.1001/jamaoncol.2018.2446 · Cited by 113 · cited 12×
“In total, 4 studies found evidence of reduced hospital LOS, as well.(34,41,43,48) The 6 studies that assessed place of death found associations between EOL discussion and death outside a hospital but generally used mixed definitions of ACP as the comparator.”
InfluentialLopez-Acevedo, M., Havrilesky, L. J., Broadwater, G., Kamal, A. H., Abernethy, A. P., Berchuck, A., Secord, A. A., Tulsky, J. A., Valea, F. A., & Lee, P. S. (2013) · Gynecologic Oncology · doi:10.1016/j.ygyno.2013.04.010 · Cited by 111
Implementation and Impact of Patient Lay Navigator-Led Advance Care Planning Conversations
Rocque, G. B., Dionne-Odom, J. N., Huang, C.-H. S., Niranjan, S. J., Williams, C., Jackson, B. E., Halilova, K. I., Kenzik, K. M., Bevis, K. S., Wallace, A. S., et al. (2017) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2016.11.012 · Cited by 109 · cited 5×
“Despite variations in discussion comparators, we found each study in the review identified some, if not many, significant associations between EOL discussion and either lower costs near EOL,(36,37,43) lower utilization of high-cost care such as acute or intensive care,(1,31,32,34,39,40,43,46-48) or reduced use or dura…”
InfluentialSchmidt, T. A., Zive, D. M., Fromme, E. K., Cook, J. N. B., & Tolle, S. W. (2014) · Resuscitation · doi:10.1016/j.resuscitation.2013.11.027 · Cited by 73
Smith-Howell, E. R., Hickman, S. E., Meghani, S. H., Perkins, S. M., & Rawl, S. M. (2016) · Journal of Palliative Medicine · doi:10.1089/jpm.2015.0314 · Cited by 62 · cited 2×
“Keywords end of life, advance care planning, goals of care, communication, decision-making, costs, health-care utilization, cancer, systematic review Introduction Aggressive, life-sustaining end-of-life (EOL) care is associated with lower quality of life,(1) family perceptions of lower quality of care,(2,3) and greate…”
Self-citationOpportunity lost: End‐of‐life discussions in cancer patients who die in the hospital
Zaros, M. C., Curtis, J. R., Silveira, M. J., & Elmore, J. G. (2012) · Journal of Hospital Medicine · doi:10.1002/jhm.1989 · Cited by 60 · cited 6×
“In total, 4 studies found evidence of reduced hospital LOS, as well.(34,41,43,48) The 6 studies that assessed place of death found associations between EOL discussion and death outside a hospital but generally used mixed definitions of ACP as the comparator.”
InfluentialPredictors of Intensive End-of-Life and Hospice Care in Latino and White Advanced Cancer Patients
Loggers, E. T., Maciejewski, P. K., Jimenez, R., Nilsson, M. E., Paulk, E., Stieglitz, H., & Prigerson, H. G. (2013) · Journal of Palliative Medicine · doi:10.1089/jpm.2013.0164 · Cited by 51 · cited 1×
“Cancer types included breast,(42) hematological,(35,33) gynecological,(1,34,48) lung or gastrointestinal,(39) and any type.(23,31,32,36-38,40,41,43,45,46,48,51) Sample sizes ranged from 84 to 2752 participants, with a median of 226 participants per study.”
Costs of Cancer Care Across the Disease Continuum
Kaye, D. R., Min, H. S., Herrel, L. A., Dupree, J. M., Ellimoottil, C. S., & Miller, D. C. (2018) · The Oncologist · doi:10.1634/theoncologist.2017-0481 · Cited by 48 · cited 1×
“Given that the costs of cancer care may vary by diagnosis, stage of disease, and treatment options(20) and that cancer disproportionately burdens racial minorities who are often diagnosed at later stages when treatment may be very expensive,(20,21) it is important to understand how care planning conversations are asso…”
Financial burden among US households affected by cancer at the end of life
Cagle, J. G., Carr, D. C., Hong, S., & Zimmerman, S. I. (2015) · Psycho-Oncology · doi:10.1002/pon.3933 · Cited by 44
Ahluwalia, S. C., Tisnado, D. M., Walling, A. M., Dy, S. M., Asch, S. M., Ettner, S. L., Kim, B. B., Pantoja, P. M., Schreibeis-Baum, H. C., & Lorenz, K. (2015) · Journal of Palliative Medicine · doi:10.1089/jpm.2014.0431 · Cited by 43 · cited 3×
“In addition, 6 studies incorporated elements of time in their assessment of EOL discussions, generally referring to these discussions as early (31þ days before death) or late (within 30 days of death), with later conversations typically occurring in inpatient settings.(1,23,31,41,48) Quality of Studies To assess study…”
Zakhour, M., LaBrant, L., Rimel, B. J., Walsh, C., Li, A. J., Karlan, B. Y., & Cass, I. A. (2015) · Gynecologic Oncology · doi:10.1016/j.ygyno.2015.06.001 · Cited by 42 · cited 8×
“001).(47) Adding context to these findings, Pedraza and colleagues found patients with POLST were more likely than patients with ADs to enroll in hospice (OR 1⁄4 2.”
InfluentialO’Connor, T. L., Ngamphaiboon, N., Groman, A. E., Luczkiewicz, D. L., Kuszczak, S. M., Grant, P. C., & Kerr, C. W. (2014) · Journal of Palliative Medicine · doi:10.1089/jpm.2014.0238 · Cited by 37 · cited 4×
“The 6 studies that assessed place of death found associations between EOL discussion and death outside a hospital but generally used mixed definitions of ACP as the comparator.(1,35,33,42,47,51) Eckhert and colleagues (n 1⁄4 163), who broadly defined an EOL discussion as an outpatient GOC discussion, AD, POLST, or DNR…”
InfluentialPedraza, S. L., Culp, S., Knestrick, M., Falkenstine, E., & Moss, A. H. (2017) · Journal of Oncology Practice · doi:10.1200/jop.2017.022566 · Cited by 36 · cited 7×
“One study was a retrospective analysis of a randomized clinical trial (RCT)(43); 1 study was nonrandomized, intervention-based(45); and 18 studies were observational.(1,23,31-42,46-48,51) Strengths of the studies included clearly stated objectives and inclusion criteria, sample sizes adequate for meeting objectives, a…”
InfluentialGieniusz, M., Nunes, R., Saha, V., Renson, A., Schubert, F. D., & Carey, J. M. (2016) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909116682470 · Cited by 36
Chemotherapy Use in the Months Before Death and Estimated Costs of Care in the Last Week of Life
Garrido, M. M., Prigerson, H. G., Bao, Y., & Maciejewski, P. K. (2016) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2015.12.323 · Cited by 35
Schulman‐Green, D., Smith, C. B., Lin, J. J., Feder, S. L., & Bickell, N. A. (2017) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2017.09.024 · Cited by 33 · cited 1×
“These conversations may include discussions about patient values, prognosis, treatment options, aspects of living and dying, or specific interventions a patient may want if certain future conditions occur—all of which may occur in advance care planning (ACP).(18) Interventions that include communication about ACP and…”
Outpatient end of life discussions shorten hospital admissions in gynecologic oncology patients
Doll, K. M., Stine, J. E., Le, L. V., Moore, D., Bae-Jump, V. L., Brewster, W. R., Soper, J. T., Boggess, J. F., Gehrig, P. A., & Kim, K. H. (2013) · Gynecologic Oncology · doi:10.1016/j.ygyno.2013.03.020 · Cited by 32 · cited 4×
“Despite variations in discussion comparators, we found each study in the review identified some, if not many, significant associations between EOL discussion and either lower costs near EOL,(36,37,43) lower utilization of high-cost care such as acute or intensive care,(1,31,32,34,39,40,43,46-48) or reduced use or dura…”
InfluentialCappell, K., Sundaram, V., Park, A., Shiraz, P., Gupta, R., Jenkins, P., Periyakoil, V. S. J., & Muffly, L. (2018) · Biology of Blood and Marrow Transplantation · doi:10.1016/j.bbmt.2018.01.014 · Cited by 27 · cited 6×
“The 6 studies that assessed place of death found associations between EOL discussion and death outside a hospital but generally used mixed definitions of ACP as the comparator.(1,35,33,42,47,51) Eckhert and colleagues (n 1⁄4 163), who broadly defined an EOL discussion as an outpatient GOC discussion, AD, POLST, or DNR…”
InfluentialO’Connor, N. R., Junker, P., Appel, S. M., Stetson, R., Rohrbach, J. I., & Meghani, S. H. (2017) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909117743475 · Cited by 26 · cited 1×
“High costs also create hardship for families, one-third of whom report spending all or most of their savings on costs related to their loved one’s terminal cancer care,(14) and for health systems tasked with managing costs while providing high-quality care.(15) Most importantly, costly aggressive care may not always r…”
Self-citationApostol, C. C., Waldfogel, J. M., Pfoh, E. R., List, D. C., Billing, L. S., Nesbit, S. A., & Dy, S. M. (2014) · Palliative Medicine · doi:10.1177/0269216314560800 · Cited by 23 · cited 5×
“Six studies received lower ratings because they did not account for confounders.(1,32,41,47,48,51) Summary of Findings End-of-life discussion associated with lower EOL costs.”
InfluentialGramling, R. E., Ingersoll, L. T., Anderson, W. G., Priest, J. S., Berns, S. H., Cheung, K. L., Norton, S. A., & Alexander, S. C. (2018) · Journal of Palliative Medicine · doi:10.1089/jpm.2018.0476 · Cited by 20 · cited 3×
“88).(23,32,35,38,39,42,47,51) Findings were strongest among studies that defined discussions based on EOL, GOC, and treatment preference conversations.”
Eckhert, E., Schoenbeck, K. L., Galligan, D. C., McNey, L. M., Hwang, J. H., & Mannis, G. N. (2017) · Bone Marrow Transplantation · doi:10.1038/bmt.2017.41 · Cited by 16 · cited 5×
“004).(35) Conceptualizing EOL discussion to also include ACP, GOC, and discussion proxies such as POLSTs and ADs, Zakhour and colleagues (n 1⁄4 136) found patients who had a discussion inpatient had much higher odds of dying in the hospital than patients who had a discussion outpatient (34% vs 0%, OR 1⁄4 20.”
InfluentialMarcia, L., Ashman, Z. W., Pillado, E. B., Kim, D. Y., & Plurad, D. S. (2018) · The American Surgeon · doi:10.1177/000313481808401005 · Cited by 8 · cited 5×
“In total, 4 studies found evidence of reduced hospital LOS, as well.(34,41,43,48) The 6 studies that assessed place of death found associations between EOL discussion and death outside a hospital but generally used mixed definitions of ACP as the comparator.”
InfluentialPedraza, S. L., Knestrick, M. W., Culp, S., Falkenstine, E. C., & Moss, A. H. (2017) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2016.12.131 · Cited by 4 · cited 1×
“001).(44) Of the 11 studies that assessed hospice use, 9 studies found significant associations with EOL discussions (ORs ranging 1.”
Research works printed but not linked: 6
- Arozullah AM, 2004, J Support Oncol, 2, 271
- O’Connor NR, 2017, Am J Hosp Palliat Care, 35, 966
- Haynes MA, 1999, The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved
- Zafar SY, 2013, Oncology (Williston Park), 27, 80
- Oxford Centre for Evidence-Based Medicine. Levels of evidence-1. 2009. https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/. Accessed November 8, 2018.
- Zafar SY, 2015, Am J Manag Care, 21, 607
Cited by
Sorted by citations
Financial toxicity in cancer care: origins, impact, and solutions
Abrams, H. R., Durbin, S., Huang, C. X., Johnson, S. F., Nayak, R., Zahner, G. J., & Peppercorn, J. M. (2021) · Translational Behavioral Medicine · doi:10.1093/tbm/ibab091 · Cited by 252
“survivorship needs [28]; and palliative or end-of-life care, conveying particularly high costs in the last days or weeks of a patient’s life [29].”
Bazargan, M., & Bazargan‐Hejazi, S. (2020) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909120966585 · Cited by 161
“Finally, reviews of research manuscripts published between January 2012 and January 2019 show that end-of-life discussions with patients with advanced cancer are associated with greater use of hospice care, greater likelihood of death outside the hospital, as well as less costly end-of-life care.(21)”
BackgroundPalmer, M. K., Jacobson, M., & Enguidanos, S. (2021) · Health Affairs · doi:10.1377/hlthaff.2020.01895 · Cited by 61
Zhang, S., Li, J., Zhang, Y., & Hu, X. (2025) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2025.105096 · Cited by 51
Living with Metastatic Cancer: A Roadmap for Future Research
Tometich, D. B., Hyland, K. A., Soliman, H. H., Jim, H., & Oswald, L. B. (2020) · Cancers · doi:10.3390/cancers12123684 · Cited by 52
“In fact, discussions between patients and providers regarding goals of care were associated with fewer hospital admissions and less aggressive treatment near end-of-life [183,184], which may improve quality of life and reduce financial toxicity [185].”
Background
Metadata
- Authors
- Starr, L. T., Ulrich, C. M., Corey, K. L., & Meghani, S. H.
- Affiliations
- Leonard Davis Institute of Health Economics (US)
- University of Pennsylvania (US)
- Corresponding author
- Starr, Lauren T.
- Venue
- American Journal of Hospice and Palliative Medicine®
- Publisher
- SAGE Publications
- Published
- 2019-05-09
- Volume
- 36
- Issue
- 10
- Pages
- 913-926
- ISSN
- 1049-9091 (ISSN-L)
- 1938-2715
- PMC
- PMC6711813
- OpenAlex
- W2944707386
- Cited by
- 132
- References
- 54
- Citations by year
- 2026: 13 · 2025: 22 · 2024: 26 · 2023: 22 · 2022: 23 · 2021: 12 · 2020: 14
- FWCI
- 2.00
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Hospice and Palliative Medicine® (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Leonard Davis Institute of Health Economics at the University of Pennsylvania (Jonas Nurse Leaders Scholars program)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- end-of-life discussions, advance care planning, goals of care discussions, advanced cancer, health care utilization, end-of-life care costs, place of death, hospice use, chemotherapy near death, quality of end-of-life care
- MeSH terms
- Communication, Health Expenditures, Health Resources, Health Services, Humans, Neoplasms, Patient Acceptance of Health Care, Patient Care Planning, Quality of Life, Severity of Illness Index, Terminal Care, Advance Care Planning
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
