Grant Number:	5R29CA079052-02 Interpret this number
Primary Investigator:	Mccarthy, Ellen
Organization:	Beth Israel Deaconess Medical Center
Project Title:	Patterns Care for Cancer Patients at End of Life
Fiscal Year:	1999

DESCRIPTION: This proposal is submitted for a first award (R29). In recent years, the way that people die in the U.S. has attracted growing public concern. As suffering cancer patients increasingly request assistance to end their lives, some argue that too little attention is paid to the quality of life in the final months. Voters in some states have sponsored referenda on the right to end one's own life when gravely ill, although the 1997 Supreme Court ruled against the right to a physician-assisted suicide. Nonetheless, those continuing to lead public calls for more individual control over the dying process have frequently been cancer patients who describe uncontrollable pain or other intolerable symptoms. Relatively little is known about the quality of the dying experience for cancer patients, especially from the patient's perspective, or about patterns of care used during the final months of life. The overall goal of this study is to describe the dying experience of cancer patients, focusing on specific types of care, the resources consumed, and whether that care complies with a patient s preferences. The project will use two complimentary databases to achieve this goal: 1. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT) database, and 2. The Surveillance, Epidemiology, and End Results (SEER) program database. Both databases have been merged with Medicare claims data for patients older than 65 years. The proposed study will be conducted in four overlapping phases, each with its own specific aims. Phase one will describe the dying experience of the seriously ill lung and colon cancer patients, including preferences for care. Phase two will describe patterns of care for cancer patients at the end of life. Phase three will examine the nature and intensity of care received at the end of life. Phase four will describe variations in end-of-life cancer care across place and time. This study will provide an in-depth description of the quality of the dying experience for selected cancer patients, and a better understanding of where cancer patients receive care during their last six months of life, the intensity of nature of their care, and whether patients' preferences for care are being respected. Information obtained from the study can be used to improve the quality of care for patients at the end of life and help to determine the nature and amount of resources that might be required to meet patients' needs.




Ethnic disparities in hospice use among Asian-American and Pacific Islander patients dying with cancer.
Authors: Ngo-Metzger Q. , Phillips R.S. , McCarthy E.P. .
Source: Journal Of The American Geriatrics Society, 2008 Jan; 56(1), p. 139-44.
PMID: 18047496
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Breast cancer risk and provider recommendation for mammography among recently unscreened women in the United States.
Authors: Sabatino S.A. , Burns R.B. , Davis R.B. , Phillips R.S. , McCarthy E.P. .
Source: Journal Of General Internal Medicine, 2006 Apr; 21(4), p. 285-91.
PMID: 16686802
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Factors associated with colon cancer screening: the role of patient factors and physician counseling.
Authors: Wee C.C. , McCarthy E.P. , Phillips R.S. .
Source: Preventive Medicine, 2005 Jul; 41(1), p. 23-9.
PMID: 15916989
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Trends in breast conserving surgery among Asian Americans and Pacific Islanders, 1992-2000.
Authors: Goel M.S. , Burns R.B. , Phillips R.S. , Davis R.B. , Ngo-Metzger Q. , McCarthy E.P. .
Source: Journal Of General Internal Medicine, 2005 Jul; 20(7), p. 604-11.
PMID: 16050854
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BMI and cervical cancer screening among white, African-American, and Hispanic women in the United States.
Authors: Wee C.C. , Phillips R.S. , McCarthy E.P. .
Source: Obesity Research, 2005 Jul; 13(7), p. 1275-80.
PMID: 16076999
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Obesity among US immigrant subgroups by duration of residence.
Authors: Goel M.S. , McCarthy E.P. , Phillips R.S. , Wee C.C. .
Source: Jama, 2004-12-15 00:00:00.0; 292(23), p. 2860-7.
PMID: 15598917
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Obesity and breast cancer screening.
Authors: Wee C.C. , McCarthy E.P. , Davis R.B. , Phillips R.S. .
Source: Journal Of General Internal Medicine, 2004 Apr; 19(4), p. 324-31.
PMID: 15061741
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Racial and ethnic disparities in cancer screening: the importance of foreign birth as a barrier to care.
Authors: Goel M.S. , Wee C.C. , McCarthy E.P. , Davis R.B. , Ngo-Metzger Q. , Phillips R.S. .
Source: Journal Of General Internal Medicine, 2003 Dec; 18(12), p. 1028-35.
PMID: 14687262
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Hospitalization of hospice patients with cancer.
Authors: Cintron A. , Hamel M.B. , Davis R.B. , Burns R.B. , Phillips R.S. , McCarthy E.P. .
Source: Journal Of Palliative Medicine, 2003 Oct; 6(5), p. 757-68.
PMID: 14622455
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Older Asian Americans and Pacific Islanders dying of cancer use hospice less frequently than older white patients.
Authors: Ngo-Metzger Q. , McCarthy E.P. , Burns R.B. , Davis R.B. , Li F.P. , Phillips R.S. .
Source: The American Journal Of Medicine, 2003 Jul; 115(1), p. 47-53.
PMID: 12867234
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Hospice use among Medicare managed care and fee-for-service patients dying with cancer.
Authors: McCarthy E.P. , Burns R.B. , Ngo-Metzger Q. , Davis R.B. , Phillips R.S. .
Source: Jama, 2003-05-07 00:00:00.0; 289(17), p. 2238-45.
PMID: 12734135
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Barriers to hospice care among older patients dying with lung and colorectal cancer.
Authors: McCarthy E.P. , Burns R.B. , Davis R.B. , Phillips R.S. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2003-02-15 00:00:00.0; 21(4), p. 728-35.
PMID: 12586813
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Dying with cancer: patients' function, symptoms, and care preferences as death approaches.
Authors: McCarthy E.P. , Phillips R.S. , Zhong Z. , Drews R.E. , Lynn J. .
Source: Journal Of The American Geriatrics Society, 2000 May; 48(5 Suppl), p. S110-21.
PMID: 10809464
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