Electronic Theses and Dissertations

Date of Award


Document Type


Degree Name

Ph.D. in Pharmaceutical Sciences

First Advisor

Sujith Ramachandran

Second Advisor

Yi Yang

Third Advisor

John P. Bentley

Relational Format



Cancer has been one of the leading causes of death for decades in the United States. It poses a significant burden to patients, stakeholders, and society in both economic (e.g., healthcare costs) and human (e.g., health-related quality of life) terms. This dissertation aimed at filling gaps in the literature on the cost and quality associated with cancer care.

First, a retrospective cross-sectional study was conducted to evaluate the effect of an alternative payment model - accountable care organizations (ACOs) - on health-related quality of life (HRQOL) and healthcare cost among patients with cancer. Findings from this study indicate that although ACOs enrollment didn’t influence healthcare expenditures, cancer survivors cared for by providers in ACOs were more likely to have greater Mental Component Summary (MCS) scores and lower Physical Component Summary (PCS) scores of HRQOL.

Second, a systematic literature review synthesized and appraised current knowledge on end-of-life (EOL) care in terms of quality indicators among adult patients with hematologic malignancies (HM). The results demonstrate that death in hospital and admission to the ICU in the last 30 days of life were the most commonly reported quality indicators of EOL for patients with HM. Additionally, this review provides evidence that a significant proportion of patients with HM receive aggressive care during the EOL period.

Finally, machine learning algorithms including Regression and Classification Trees, Random Forests, and Gradient Boosting Machine were adopted to build and optimize models to predict high-cost cancer patients during the EOL period in national Medicare data. Among all the models, the Random Forests model was the top-performing model.

Study findings of this dissertation on the cost and quality of cancer care are valuable for healthcare professionals, payers, and policy makers to improve the HRQOL, reduce the healthcare costs, and improve EOL care management for patients with cancer.


Pharmacy Administration



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