End-of-life care for elderly patients with advanced lung cancer in the United States and Ontario.
Bibliographic record
Abstract
6021 Background: Although the health care systems in the U.S. and Canada differ, both have government-sponsored health insurance for the elderly. Approaches to end of life care also vary between the U.S., which offers Medicare's comprehensive hospice program, and Canada, which has a fragmented system of palliative care. Little research has compared end of life care for elderly in the two countries. Purpose: To compare the types and intensity of end of life care in elderly non-small cell lung cancer (NSCLC) patients in the U.S. and the province of Ontario, Canada. Methods: The linked SEER-Medicare data were used to identify care for 12,198 NSCLC patients with advanced disease at diagnosis who died of cancer between 1999 and 2003 in the U.S. Comparable NSCLC patients (n = 8,100) from the Ontario Cancer Registry were linked with their health claims. Outcomes evaluated were use of chemotherapy, ER visits, inpatient hospitalizations, supportive care, and deaths in hospital. Rates of service use were estimated by person-months and adjusted for age, income, sex, and urbanicity. Results: Rates of chemotherapy use were higher in the U.S. than in Ontario, and declined during the last six months of life. Rates of hospice and palliative care use increased dramatically during the last six months, and in the last 30 days, more than half of patients received hospice care in the U.S. or palliative care in Ontario. During the last 30 days, patients in Ontario were more likely than in the U.S. to have an ER visit (50.7% vs. 39.8%), be hospitalized (54.4% vs. 45.9%), and die in hospital (51.9% vs. 20.3%). Conclusions: NSCLC patients received extensive acute and supportive care services during the last six months of life. Differences in end of life care between the U.S. and Ontario reflect the availability of comprehensive approaches to end of life care as well as attitudes of physicians and patients. Determining the optimal model of end of life care requires consideration of factors such as patient and family quality of life, as well as health system and patient-borne costs. No significant financial relationships to disclose.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".