Objectives:
To examine the patterns of utilization of
radiation therapy,
chemotherapy,
surgery, and
hospice at the end-of-life care for patients diagnosed with metastatic melanoma.
Methods:
We identified 816 Medicare beneficiaries toward who were 65 years of age or older, with pathologically confirmed metastatic malignant melanoma between January 1, 2000, and December 31, 2007. We evaluated trends and associations between sociodemographic and health service characteristics and the use of
hospice care,
chemotherapy,
surgery, and
radiation therapy.
Results:
We found increasing use of
surgery for patients with metastatic melanoma from 13% in 2000 to 30% in 2007 (
P=0.03 for trend), and no significant fluctuation in the use of
chemotherapy (
P=0.43) or
radiation therapy (
P=0.46). Older patients were less likely to receive
radiation therapy or
chemotherapy. The use of
hospice care increased from 61% in 2000 to 79% in 2007 (
P=0.07 for trend). Enrollment in short-term (1 to 3 d)
hospice care use increased, whereas long-term
hospice care (≥4 d) remained stable. Patients living in the SEER (Surveillance, Epidemiology and End Results) northeast and south regions were less likely to undergo
surgery. Patients enrolled in long-term
hospice care used significantly less
chemotherapy,
surgery, and
radiation therapy.
Conclusions:
Surgery and
hospice care use increased over the years of this study, whereas the use of
chemotherapy and
radiation therapy remained consistent for patients diagnosed with metastatic melanoma.
