According to a descriptive report on the costs of end-of-life cancer care for patients with colorectal cancer (CRC) in the United States and Ontario, Canada, decreasing chemotherapy and intensive care unit (ICU) use in the United States and hospitalizations in Ontario could reduce costs associated with care. These results were published in the Journal of Oncology Practice.

End-of-life cancer care is expensive, with costs associated with intensity and location of care significantly affecting the overall cost.

In this study, researchers assessed data from patients with CRC diagnosed between 2007 and 2013 and who died from any cancer between 2007 and 2013. All patients were at least 66 years old. For data in the United States, researchers used the Surveillance, Epidemiology, and End Results (SEER) Program linked to Medicare claims, with a total of 16,565 patients’ data included. For data in Ontario, researchers used the Ontario Cancer Registry linked to administrative health data, with a total of 6587 patients’ data included.

Estimates of total and resource-specific costs were made in 2015 US dollars from public payer perspectives across the last 360 days of life by 30-day periods, by stage at diagnosis of 0 to II, III, and IV.

A higher proportion of SEER-Medicare patients (15.7%) than Ontario patients (8.0%) received chemotherapy across all months, and especially in the final 30 days preceding death. Similarly, more SEER-Medicare patients (39.4%) than Ontario patients (31.3%) underwent imaging tests in the final months and especially the final 30 days of life.

More Ontario patients (62.5%) were hospitalized than SEER-Medicare patients (51.0%), though of the hospitalized patients, more SEER-Medicare patients (43.2%) were admitted to the ICU than Ontario patients (17.9%).

Cost differences based on disease stage at diagnosis were larger for patients with advanced (stage IV) disease. In the final 30 days of life, average total costs for patients with stage IV disease were $15,881 for SEER-Medicare patients and $12,034 for Ontario patients vs $19,354 for SEER-Medicare and $17,312 for Ontario patients with stage 0 to II disease.

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Cost of hospitalization was higher for SEER-Medicare patients ($11,180) vs Ontario patients ($9434), which is at least partially attributable to the higher daily hospital costs for SEER-Medicare patients ($2004) vs Ontario patients ($1067).

“[O]ur descriptive study of health care use and costs at the [end of life] in similar groups of older patients with CRC, although not supporting a direct comparison of 2 health systems, generated hypotheses concerning areas for improvement in service delivery and lower costs in both settings. In Ontario, improving coordination of EOL care and reducing hospitalizations and in-hospital deaths could provide savings. Reducing daily hospital costs and intensity of health care services for SEER-Medicare patients, especially those with stage IV disease at diagnosis, could reduce costs to the Medicare program and decrease the financial burden on patients and families,” concluded the authors.


Bremner KE, Yabroff KR, Coughlan D, et al. Patterns of care and costs for older patients with colorectal cancer at the end of life: descriptive study of the United States and Canada. J Oncol Pract. doi: 10.1200/JOP.19.00061.