The following is a summary of “Effect of the COVID-19 Pandemic on Place of Death Among Medicaid and Commercially Insured Patients With Cancer in Washington State,” published in the March 2023 issue of Oncology by Panattoni, et al.
For a study, researchers sought to investigate the impact of the COVID-19 pandemic on end-of-life care in cancer patients, specifically changes in place of death and hospice support for Medicaid and commercially insured patients.
The study included patients with solid tumors aged 18-64 years in Washington State. The researchers linked cancer registry records with claims from Medicaid and two commercial insurers. The study group comprised 322 Medicaid and 162 commercial patients who died between March 2017 and June 2019 (pre–COVID-19), along with 90 Medicaid and 47 commercial patients who died between March and June 2020 (COVID-19). The place of death was categorized as hospital, hospice (home or nonhospital facility), and home without hospice. The place of death was compared using adjusted multinomial logistic regressions stratified by the payer and time period (pre–COVID-19 v COVID-19). In addition, the clinical and sociodemographic factors associated with dying at home without hospice were examined, and adjusted marginal effects (ME) were reported.
Medicaid patients had a higher risk of dying in a hospital in the adjusted pre-COVID-19 analysis (48% vs. 36%; adjusted ME, 11%; P =.02) than patients with commercial insurance. However, Medicaid patients’ places of death changed in the pre-COVID-19/COVID-19 analysis, moving from hospitals (48% vs. 32%; ME, -16%; P< .01) to homes without hospice (19.9% vs. 38.0%; ME, 16.5%; P< .01). For commercial patients, there were no statistically significant variations between pre-COVID-19 and pre-COVID-19, nevertheless. As a result, during COVID-19, patients on Medicaid were more likely than patients on commercial insurance to pass away at home without hospice care (38% vs. 22%; ME, 16%; P =.04), and patients who were male or female were more likely to pass away (ME, 16%; P< .01).
The study’s findings suggested that the COVID-19 pandemic may have disproportionately impacted end-of-life care for Medicaid enrollees with cancer. The results indicated a shift in the place of death for Medicaid patients from the hospital to home without hospice during COVID-19. The study highlighted the need for attention to be paid to societal and health system factors that decrease access to care for Medicaid patients.