Do not resuscitate orders and the costs and utilization of oncology services at the end of life

With the cost of cancer care rising faster than for any other disease, systematic efforts should focus on eliminating waste in the form of ineffective therapies with virtually no benefit to the patient. The objective of this study is to compare the utilization and costs of oncology care at the end of life in the state of California by comparing oncology care for patients who did or did not receive a Do Not Resuscitate (DNR) order. Claims from patients with a diagnosis of liver, lung, and pancreatic cancer were examined to identify trends in the use of oncology interventions during the last hospital stay before death. Logistic regression models were used to analyze costs and charges among the two cohorts. Results indicated average costs and charges for patients with a DNR order were less than half the costs and charges of those patients who did not have a DNR order.