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Utilization of Surgery, Chemotherapy, Radiation Therapy, and Hospice at the End of Life for Patients Diagnosed With Metastatic Melanoma

Huo, Jinhai MD, MPH*,†; Du, Xianglin L. MD, PhD†,‡; Lairson, David R. PhD; Chan, Wenyaw PhD§; Jiang, Jing MS; Buchholz, Thomas A. MD*; Guadagnolo, B. Ashleigh MD, MPH*

American Journal of Clinical Oncology: June 2015 - Volume 38 - Issue 3 - p 235–241
doi: 10.1097/COC.0b013e31829378f9
Original Articles: Palliative Care
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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.

Departments of *Radiation Oncology

Biostatistics, University of Texas MD Anderson Cancer Center

Divisions of Management, Policy and Community Health

Epidemiology, Human Genetics, and Environmental Sciences

§Biostatistics, University of Texas School of Public Health, Houston, TX

Supported by a grant from the National Institutes of Health/National Cancer Institute (1R21CA164449-01A1 to B.A.G.), a grant from the Agency for Healthcare Research and Quality (grant # R01-HS018956) and a grant from the Cancer Prevention and Research Institute of Texas (Multi-Investigator Award grant # RP101207).

The authors declare no conflicts of interest.

Reprints: B. Ashleigh Guadagnolo, MD, MPH, Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030. E-mail: aguadagn@mdanderson.org.

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