(B-219) Estimating Health Care Contact Days for Medicare Beneficiaries Diagnosed with Metastatic Breast, Colorectal, Lung or Prostate Cancer, 2008-2019

Background: Health care contact days—defined as days obtaining care outside a patient’s home —serve as a measure of how much of life is consumed receiving health care. Older adults with metastatic cancer may have particularly high health care contact days.

Objectives: To assess patterns of health care contact days among Medicare beneficiaries diagnosed with one of four high-incidence cancers: breast, colorectal, lung, and prostate.

Methods: In this cohort study, we used the SEER-Medicare linked database to identify beneficiaries who were diagnosed with metastatic breast, colorectal, lung, or prostate cancers from 2008 to 2019, aged 66 years or older at diagnosis, and continuously enrolled in fee-for-service Medicare Parts A and B in the 12 months before and after diagnosis. We calculated total contact days (sum of days in ambulatory or institutional care settings) in the year following diagnosis. We used descriptive statistics to assess health care contact days over the study period and multivariable negative binomial regression models, adjusting for sociodemographic and health-related characteristics, to examine whether health care contact days changed over time.

Results: Our study included 55,806 beneficiaries diagnosed with metastatic cancer, including 6,495 with breast, 10,232 with colorectal, 27,340 with lung, and 11,739 with prostate cancers. Beneficiaries with colorectal cancer had the highest median health care contact days (62, IQR: 32-87), followed by those with lung cancer (60, IQR: 26-86), breast cancer (43, IQR: 3-72), and prostate cancer (33, IQR: 1-59). From 2008 to 2018, mean health care contact days increased across all cancer types: breast cancer: 44.9 (95% CI 38.7-52.2) versus 63.7 (95% CI 54.5-74.4); colorectal cancer: 52.0 (95% CI 47.5-56.9) versus 58.2 (95% CI 53.8-63.0); lung cancer: 42.9 (95% CI 40.5-45.4) versus 48.9 (95% CI 46.5-51.4); and prostate cancer 29.6 (95% CI 26.2-33.3) versus 35.9 (95% CI 32.4-39.8).

Conclusions: In the year following diagnosis, Medicare beneficiaries with four common metastatic cancers spent a median of 33 to 62 days obtaining health care outside the home. Health care contact days increased from 2008 to 2018 for all four cancer types, suggesting that treatment advancements and inefficiencies in care might have imposed additional burdens on beneficiaries and their care partners over time. Future research should examine the appropriateness of received care and assess drivers of health care contact days to lessen the time burden of, and to right-size care for, older adults with cancer.