ArticleHealth affairs (Project Hope)2018
Factors Contributing To Geographic Variation In End-Of-Life Expenditures For Cancer Patients.
Article in Health affairs (Project Hope), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it, 46 citations in OpenAlex.
- Impact of socioeconomic status on end-of-life costs: a systematic review and meta-analysis.BMC palliative care · 2020Pooled it
- Effect of Documenting Prognosis on the Information Provided to ICU Proxies: A Randomized Trial.Critical care medicine · 2019Trial
- Practice-Level Spending Variation for Radiation Treatment Episodes Among Older Adults With Cancer.JAMA health forum · 2025Article
- Predictors and Drivers of End-of-Life Medicare Spending Among Older Adults with Solid Tumors: A Population-Based Study.Cancers · 2025Article
- Contemporary Patterns of End-of-Life Care Among Medicare Beneficiaries With Advanced Cancer.JAMA health forum · 2025Article
- Regional Variation in End-of-life Care Just Before Death Among the Oldest Old in Japan: A Descriptive Study.Journal of epidemiology · 2024Article
- Identification and classification of principal features for analyzing unwarranted clinical variation.Journal of evaluation in clinical practice · 2024Review
- Associations between demographics and clinical ideology, beliefs, and practice patterns: a secondary analysis of a survey of randomly sampled United States chiropractors.BMC complementary medicine and therapies · 2023Article
- Elevated end-of-life spending: A new measure of potentially wasteful health care spending at the end of life.Health services research · 2023Article
- Serious Illness Conversation Training for Inpatient Medical Oncology Advanced Practice Providers: A Quality Improvement Project.Journal of the advanced practitioner in oncology · 2023Article
- Goals of care documentation by medical oncologists and oncology patient end-of-life care outcomes.Cancer · 2022Article
- Physician Influence on Variation in Receipt of Aggressive End-of-Life Care Among Women Dying of Ovarian Cancer.JCO oncology practice · 2022Article
- Article
- How Well Does the Surprise Question Predict 1-year Mortality for Patients Admitted with COPD?Journal of general internal medicine · 2021Article
- Social Determinants of Health and Geographic Variation in Medicare per Beneficiary Spending.JAMA network open · 2021Article
- End-of-Life Cost Trajectories in Cancer Patients Treated by Medicare versus the Veterans Health Administration.Journal of the American Geriatrics Society · 2021Article
- Survival of Ventilated Extremely Premature Neonates With Severe Intraventricular Hemorrhage.Pediatrics · 2021Article
- First-line treatment in older patients with Hodgkin lymphoma: a Surveillance, Epidemiology, and End Results (SEER)-Medicare population-based study.British journal of haematology · 2020Article
- Association Between Delivery System Structure and Intensity of End-of-Life Cancer Care.JCO oncology practice · 2020Article
- Use of Hospital Referral Regions in Evaluating End-of-Life Care.Journal of palliative medicine · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 5 institutions in 3 countries.
Funding
Abstract
Health care spending in the months before death varies across geographic areas but is not associated with outcomes. Using data from the prospective multiregional Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) study, we assessed the extent to which such variation is explained by differences in patients' sociodemographic factors, clinical factors, and beliefs; physicians' beliefs; and the availability of services. Among 1,132 patients ages sixty-five and older who were diagnosed with lung or colorectal cancer in 2003-05, had advanced-stage cancer, died before 2013, and were enrolled in fee-for-service Medicare, mean expenditures in the last month of life were $13,663. Physicians in higher-spending areas reported less knowledge about and comfort with treating dying patients and less positive attitudes about hospice, compared to those in lower-spending areas. Higher-spending areas also had more physicians and fewer primary care providers and hospices in proportion to their total population than lower-spending areas did. Availability of services and physicians' beliefs, but not patients' beliefs, were important in explaining geographic variations in end-of-life spending. Enhanced training to better equip physicians to care for patients at the end of life and strategic resource allocation may have potential for decreasing unwarranted variation in care.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.