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Algu K, Wales J, Anderson M, Omilabu M, Briggs T, Kurahashi AM. Naming racism as a root cause of inequities in palliative care research: a scoping review. BMC Palliat Care 2024; 23:143. [PMID: 38858646 PMCID: PMC11163751 DOI: 10.1186/s12904-024-01465-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/22/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Racial and ethnic inequities in palliative care are well-established. The way researchers design and interpret studies investigating race- and ethnicity-based disparities has future implications on the interventions aimed to reduce these inequities. If racism is not discussed when contextualizing findings, it is less likely to be addressed and inequities will persist. OBJECTIVE To summarize the characteristics of 12 years of academic literature that investigates race- or ethnicity-based disparities in palliative care access, outcomes and experiences, and determine the extent to which racism is discussed when interpreting findings. METHODS Following Arksey & O'Malley's methodology for scoping reviews, we searched bibliographic databases for primary, peer reviewed studies globally, in all languages, that collected race or ethnicity variables in a palliative care context (January 1, 2011 to October 17, 2023). We recorded study characteristics and categorized citations based on their research focus-whether race or ethnicity were examined as a major focus (analyzed as a primary independent variable or population of interest) or minor focus (analyzed as a secondary variable) of the research purpose, and the interpretation of findings-whether authors directly or indirectly discussed racism when contextualizing the study results. RESULTS We identified 3000 citations and included 181 in our review. Of these, most were from the United States (88.95%) and examined race or ethnicity as a major focus (71.27%). When interpreting findings, authors directly named racism in 7.18% of publications. They were more likely to use words closely associated with racism (20.44%) or describe systemic or individual factors (41.44%). Racism was directly named in 33.33% of articles published since 2021 versus 3.92% in the 10 years prior, suggesting it is becoming more common. CONCLUSION While the focus on race and ethnicity in palliative care research is increasing, there is room for improvement when acknowledging systemic factors - including racism - during data analysis. Researchers must be purposeful when investigating race and ethnicity, and identify how racism shapes palliative care access, outcomes and experiences of racially and ethnically minoritized patients.
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Affiliation(s)
- Kavita Algu
- Temmy Latner Centre for Palliative Care, 60 Murray Street, 4th Floor, Box 13, Toronto, ON, M5T3L9, Canada.
| | - Joshua Wales
- Temmy Latner Centre for Palliative Care, 60 Murray Street, 4th Floor, Box 13, Toronto, ON, M5T3L9, Canada
| | - Michael Anderson
- Waakebiness-Bryce Institute for Indigenous Health, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada
| | - Mariam Omilabu
- Temmy Latner Centre for Palliative Care, 60 Murray Street, 4th Floor, Box 13, Toronto, ON, M5T3L9, Canada
| | - Thandi Briggs
- Home and Community Care Support Services Toronto Central, 250 Dundas St. W, Toronto, ON, M5T 2Z5, Canada
| | - Allison M Kurahashi
- Temmy Latner Centre for Palliative Care, 60 Murray Street, 4th Floor, Box 13, Toronto, ON, M5T3L9, Canada
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Coles CE, Earl H, Anderson BO, Barrios CH, Bienz M, Bliss JM, Cameron DA, Cardoso F, Cui W, Francis PA, Jagsi R, Knaul FM, McIntosh SA, Phillips KA, Radbruch L, Thompson MK, André F, Abraham JE, Bhattacharya IS, Franzoi MA, Drewett L, Fulton A, Kazmi F, Inbah Rajah D, Mutebi M, Ng D, Ng S, Olopade OI, Rosa WE, Rubasingham J, Spence D, Stobart H, Vargas Enciso V, Vaz-Luis I, Villarreal-Garza C. The Lancet Breast Cancer Commission. Lancet 2024; 403:1895-1950. [PMID: 38636533 DOI: 10.1016/s0140-6736(24)00747-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/18/2023] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Affiliation(s)
| | - Helena Earl
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Benjamin O Anderson
- Global Breast Cancer Initiative, World Health Organisation and Departments of Surgery and Global Health Medicine, University of Washington, Seattle, WA, USA
| | - Carlos H Barrios
- Oncology Research Center, Hospital São Lucas, Porto Alegre, Brazil
| | - Maya Bienz
- Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, London, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - David A Cameron
- Institute of Genetics and Cancer and Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Wanda Cui
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Prudence A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Reshma Jagsi
- Emory University School of Medicine, Atlanta, GA, USA
| | - Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA; Tómatelo a Pecho, Mexico City, Mexico
| | - Stuart A McIntosh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Kelly-Anne Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | | | | | - Jean E Abraham
- Department of Oncology, University of Cambridge, Cambridge, UK
| | | | | | - Lynsey Drewett
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | | | - Farasat Kazmi
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | - Dianna Ng
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Szeyi Ng
- The Institute of Cancer Research, London, UK
| | | | - William E Rosa
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | | | | | | | | | | | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
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Pearson SA, Taylor S, Marsden A, O'Reilly JD, Krishan A, Howell S, Yorke J. Geographic and sociodemographic access to systemic anticancer therapies for secondary breast cancer: a systematic review. Syst Rev 2024; 13:35. [PMID: 38238821 PMCID: PMC10795363 DOI: 10.1186/s13643-023-02382-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 11/03/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The review aimed to investigate geographic and sociodemographic factors associated with receipt of systemic anticancer therapies (SACT) for women with secondary (metastatic) breast cancer (SBC). METHODS Included studies reported geographic and sociodemographic factors associated with receipt of treatment with SACT for women > 18 years with an SBC diagnosis. Information sources searched were Ovid CINAHL, Ovid MEDLINE, Ovid Embase and Ovid PsychINFO. Assessment of methodological quality was undertaken using the Joanna Briggs Institute method. Findings were synthesised using a narrative synthesis approach. RESULTS Nineteen studies published between 2009 and 2023 were included in the review. Overall methodological quality was assessed as low to moderate. Outcomes were reported for treatment receipt and time to treatment. Overall treatment receipt ranged from 4% for immunotherapy treatment in one study to 83% for systemic anticancer therapies (unspecified). Time to treatment ranged from median 54 days to 95 days with 81% of patients who received treatment < 60 days. Younger women, women of White origin, and those women with a higher socioeconomic status had an increased likelihood of timely treatment receipt. Treatment receipt varied by geographical region, and place of care was associated with variation in timely receipt of treatment with women treated at teaching, research and private institutions being more likely to receive treatment in a timely manner. CONCLUSIONS Treatment receipt varied depending upon type of SACT. A number of factors were associated with treatment receipt. Barriers included older age, non-White race, lower socioeconomic status, significant comorbidities, hospital setting and geographical location. Findings should however be interpreted with caution given the limitations in overall methodological quality of included studies and significant heterogeneity in measures of exposure and outcome. Generalisability was limited due to included study populations. Findings have practical implications for the development and piloting of targeted interventions to address specific barriers in a socioculturally sensitive manner. Addressing geographical variation and place of care may require intervention at a commissioning policy level. Further qualitative research is required to understand the experience and of women and clinicians. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020196490.
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Affiliation(s)
- Sally Anne Pearson
- Division of Nursing, Midwifery and Social Work, The Christie NHS Foundation Trust, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Sally Taylor
- Christie Patient Centred Research, The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, M20 4BX, UK
| | - Antonia Marsden
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Jessica Dalton O'Reilly
- Christie Patient Centred Research, The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, M20 4BX, UK
| | - Ashma Krishan
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Sacha Howell
- Division of Cancer Sciences, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
| | - Janelle Yorke
- Division of Nursing, Midwifery and Social Work, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
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Jalali FS, Seif M, Jafari A, Zangouri V, Keshavarz K, Ravangard R. Factors affecting the economic burden of breast cancer in southern Iran. BMC Health Serv Res 2023; 23:1332. [PMID: 38041035 PMCID: PMC10691120 DOI: 10.1186/s12913-023-10346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 11/18/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Breast cancer (BC) is the most common cancer in the world, and is associated with significant economic costs for patients and communities. Therefore, the information on the costs of the disease and the identification of its underlying factors will provide insights into designing effective interventions and reducing the costs. Thus, the present study aimed to identify the factors affecting the economic burden of breast cancer from all medical centers providing diagnostic and treatment services in southern Iran. METHODS A list of factors affecting the economic burden of breast cancer was obtained based on the effective factors searched in the databases, including PubMed, ProQuest, Scopus, ISI Web of Science, SID, and Magiran, and the opinions of BC cancer specialists. Then, the data on 460 breast cancer patients was collected from March 2020 to March 2022. The relationship between the factors affecting Breast Cancer costs was analyzed using SPSS 13.0 software by the use of multiple regression analysis. RESULTS The results of the multiple regression analysis showed that stages (P-value < 0.001), being an extreme user (p = 0.025), type of treatment center (P-value < 0.001), income (P-value < 0.001), chemotherapy side effects (P-value < 0.001), and distance to the nearest health center (P-value < 0.001) were important factors affecting the costs of breast cancer patients. CONCLUSIONS According to the results, encouraging people to undergo annual screenings, increasing insurance coverage, assuring the patients about the desirability and adequacy of the provided medical services, deploying specialists in chemotherapy centers (especially nutritionists) to recommend special diets, and establishing cancer diagnostic and treatment centers in high-population cities could help reduce the costs of breast cancer patients.
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Affiliation(s)
- Faride Sadat Jalali
- Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhgan Seif
- Non-communicable Disease Research Center, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdosaleh Jafari
- Health Human Resources Research Centre, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vahid Zangouri
- Breast Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khosro Keshavarz
- Health Human Resources Research Centre, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ramin Ravangard
- Health Human Resources Research Centre, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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5
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Kajimoto Y, Honda K, Nozawa K, Mukai M, Teng L, Igarashi A. Use of Anticancer Therapies and Economic Burden Near the End of Life in Japan: Results From Claims Database. JCO Glob Oncol 2022; 8:e2200227. [PMID: 36455173 PMCID: PMC10166540 DOI: 10.1200/go.22.00227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
PURPOSE In patients with cancer, aggressive treatment near the end of life (EOL) may decrease quality of life and increase medical costs. In this study, we examined the use of anticancer therapies near the EOL in Japan. METHODS We used a commercial database of health insurance claims in Japan, to examine patient data on cancer and death until August 2020. We assessed the proportion of patients using anticancer therapies within 14 days of death, associated factors, and medical costs from the payer's perspective. RESULTS The database documented 5,759 patients with cancer who died between December 2013 and August 2020. Among them, 4.8% of patients and 3.9% of age-adjusted patients received anticancer therapy within 14 days of death. Patients age < 60 years were associated with a high probability of receiving anticancer therapy near the EOL. The estimated annual anticancer therapy and related costs were Japanese yen 1,296 million (US dollars 12.6 million). CONCLUSION We found the percentage of patients receiving anticancer therapies within 14 days of death in Japan, its associated factors, and economic burden. Our findings can serve as a benchmark for optimizing EOL care.
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Affiliation(s)
- Yusuke Kajimoto
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan.,Oncology Science Unit, MSD. K.K., Tokyo, Japan
| | - Kazunori Honda
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kazuki Nozawa
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Mineko Mukai
- Nursing Department, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Lida Teng
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Ataru Igarashi
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan.,Unit of Public Health and Preventive Medicine, Yokohama City University School of Medicine, Yokohama, Japan
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Hung P, Cramer LD, Pollack CE, Gross CP, Wang S. Primary care physician continuity, survival, and end-of-life care intensity. Health Serv Res 2022; 57:853-862. [PMID: 34386976 PMCID: PMC9264461 DOI: 10.1111/1475-6773.13869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the associations of primary care physician (PCP) care continuity with cancer-specific survival and end-of-life care intensity. DATA SOURCES Surveillance, epidemiology, and end results linked to Medicare claims data from 2001 to 2015. STUDY DESIGN Cox proportional hazards models with mixed effects and hierarchical generalized logistic models were used to examine the associations of PCP care continuity with cancer-specific survival and end-of-life care intensity, respectively. PCP care continuity, defined as having visited the predominant PCP (who saw the patient most frequently before diagnosis) within 6 months of diagnosis. DATA EXTRACTION METHODS We identified Medicare patients diagnosed at age 66.5-94 years with stage-III or IV poor-prognosis cancer during 2001-2012 and followed them up until 2015. Patients who died within 6 months after diagnosis were excluded. PRINCIPAL FINDINGS Primary study cohort consisted of 85,467 patients (median survival 22 months), 71.7% of whom had PCP care continuity. Patients with PCP care continuity tended to be older, married, nonblack, non-Hispanic, and to have fewer comorbid conditions (p < 0.001 for all). Patients with PCP care continuity had lower cancer-specific mortality (adjusted hazard ratio: 0.93; 95% confidence interval [CI]: 0.91 to 0.95; p = 0.001) than did those without PCP care continuity. Findings of the 2001-2003 cohorts (nearly all of whom died by 2015) show no associations of overall end-of-life care intensity measures with PCP care continuity (adjusted marginal effects: 0.005; 95% CI: -0.016 to 0.026; p = 0.264). CONCLUSIONS Among Medicare beneficiaries with advanced poor-prognosis cancer, PCP continuity was associated with modestly improved survival without raising overall aggressive end-of-life care.
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Affiliation(s)
- Peiyin Hung
- Department of Health Services Policy and ManagementUniversity of South Carolina Arnold School of Public HealthColumbiaSouth CarolinaUSA
| | - Laura D. Cramer
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of MedicineNew HavenConnecticutUSA
| | - Craig E. Pollack
- Division of General Internal MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Departmental Health Policy and ManagementJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Cary P. Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of MedicineNew HavenConnecticutUSA
- Department of Chronic Disease EpidemiologyYale University School of Public HealthNew HavenConnecticutUSA
- Department of Internal MedicineYale University School of MedicineNew HavenConnecticutUSA
| | - Shi‐Yi Wang
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of MedicineNew HavenConnecticutUSA
- Department of Chronic Disease EpidemiologyYale University School of Public HealthNew HavenConnecticutUSA
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7
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Malhotra C, Bundoc F, Chaudhry I, Teo I, Ozdemir S, Finkelstein E, Dent RA, Kumarakulasinghe NB, Cheung YB, Malhotra R, Kanesvaran R, Yee ACP, Chan N, Wu HY, Chin SM, Allyn HYM, Yang GM, Neo PSH, Harding R, Heng LL. A prospective cohort study assessing aggressive interventions at the end-of-life among patients with solid metastatic cancer. Palliat Care 2022; 21:73. [PMID: 35578270 PMCID: PMC9109395 DOI: 10.1186/s12904-022-00970-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 04/12/2022] [Indexed: 01/08/2023] Open
Abstract
Background Many patients with a solid metastatic cancer are treated aggressively during their last month of life. Using data from a large prospective cohort study of patients with an advanced cancer, we aimed to assess the number and predictors of aggressive interventions during last month of life among patients with solid metastatic cancer and its association with bereaved caregivers’ outcomes. Methods We used data of 345 deceased patients from a prospective cohort study of 600 patients. We surveyed patients every 3 months until death for their physical, psychological and functional health, end-of-life care preference and palliative care use. We surveyed their bereaved caregivers 8 weeks after patients’ death regarding their preparedness about patient’s death, regret about patient’s end-of-life care and mood over the last week. Patient data was merged with medical records to assess aggressive interventions received including hospital death and use of anti-cancer treatment, more than 14 days in hospital, more than one hospital admission, more than one emergency room visit and at least one intensive care unit admission, all within the last month of life. Results 69% of patients received at least one aggressive intervention during last month of life. Patients hospitalized during the last 2–12 months of life, male patients, Buddhist or Taoist, and with breast or respiratory cancer received more aggressive interventions in last month of life. Patients with worse functional health prior to their last month of life received fewer aggressive interventions in last month of life. Bereaved caregivers of patients receiving more aggressive interventions reported feeling less prepared for patients’ death. Conclusion Findings suggest that intervening early in the sub-group of patients with history of hospitalization prior to their last month may reduce number of aggressive interventions during last month of life and ultimately positively influence caregivers’ preparedness for death during the bereavement phase. Trial registration NCT02850640. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00970-z.
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8
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Greer JA, Moy B, El-Jawahri A, Jackson VA, Kamdar M, Jacobsen J, Lindvall C, Shin JA, Rinaldi S, Carlson HA, Sousa A, Gallagher ER, Li Z, Moran S, Ruddy M, Anand MV, Carp JE, Temel JS. Randomized Trial of a Palliative Care Intervention to Improve End-of-Life Care Discussions in Patients With Metastatic Breast Cancer. J Natl Compr Canc Netw 2022; 20:136-143. [PMID: 35130492 DOI: 10.6004/jnccn.2021.7040] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/05/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Studies show that early, integrated palliative care (PC) improves quality of life (QoL) and end-of-life (EoL) care for patients with poor-prognosis cancers. However, the optimal strategy for delivering PC for those with advanced cancers who have longer disease trajectories, such as metastatic breast cancer (MBC), remains unknown. We tested the effect of a PC intervention on the documentation of EoL care discussions, patient-reported outcomes, and hospice utilization in this population. PATIENTS AND METHODS Patients with MBC and clinical indicators of poor prognosis (n=120) were randomly assigned to receive an outpatient PC intervention (n=61) or usual care (n=59) between May 2, 2016, and December 26, 2018, at an academic cancer center. The intervention entailed 5 structured PC visits focusing on symptom management, coping, prognostic awareness, decision-making, and EoL planning. The primary outcome was documentation of EoL care discussions in the electronic health record (EHR). Secondary outcomes included patient-report of discussions with clinicians about EoL care, QoL, and mood symptoms at 6, 12, 18, and 24 weeks after baseline and hospice utilization. RESULTS The rate of EoL care discussions documented in the EHR was higher among intervention patients versus those receiving usual care (67.2% vs 40.7%; P=.006), including a higher completion rate of a Medical Orders for Life-Sustaining Treatment form (39.3% vs 13.6%; P=.002). Intervention patients were also more likely to report discussing their EoL care wishes with their doctor (odds ratio [OR], 3.10; 95% CI, 1.21-7.94; P=.019) and to receive hospice services (OR, 4.03; 95% CI, 1.10-14.73; P=.035) compared with usual care patients. Study groups did not differ in patient-reported QoL or mood symptoms. CONCLUSIONS This PC intervention significantly improved rates of discussion and documentation regarding EoL care and delivery of hospice services among patients with MBC, demonstrating that PC can be tailored to address the supportive care needs of patients with longer disease trajectories. ClinicalTrials.gov identifier: NCT02730858.
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Affiliation(s)
- Joseph A Greer
- Massachusetts General Hospital.,Harvard Medical School, and
| | - Beverly Moy
- Massachusetts General Hospital.,Harvard Medical School, and
| | | | | | - Mihir Kamdar
- Massachusetts General Hospital.,Harvard Medical School, and
| | | | - Charlotta Lindvall
- Harvard Medical School, and.,Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Simone Rinaldi
- Massachusetts General Hospital.,Harvard Medical School, and
| | | | - Angela Sousa
- Massachusetts General Hospital.,Harvard Medical School, and
| | | | - Zhigang Li
- University of Florida, Gainesville, Florida
| | - Samantha Moran
- Massachusetts General Hospital Institute of Health Professions, Boston, Massachusetts
| | - Magaret Ruddy
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Maya V Anand
- University of Rochester School of Medicine and Dentistry, Rochester, New York; and
| | - Julia E Carp
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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9
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Schmitz RSJM, Geurts SME, Ibragimova KIE, Tilli DJP, Tjan-Heijnen VCG, de Boer M. Healthcare Use during the Last Six Months of Life in Patients with Advanced Breast Cancer. Cancers (Basel) 2021; 13:cancers13215271. [PMID: 34771434 PMCID: PMC8582356 DOI: 10.3390/cancers13215271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary In the last decades, new treatment options for advanced (breast) cancer have resulted in increased use of health care resources near the end of life. We assessed health care use near the end of life of patients with advanced breast cancer (ABC). In this study, we have shown that ICU admission, and CPR occurred rarely during the last six months of life of ABC patients. However, hospital admissions occurred often, especially in patients who received new chemotherapy within 30 days of end of life. Those patients were also more likely to die in the hospital. However, death was most often due to disease progression. To improve quality of life near the end of life of advanced breast cancer patients, it is vital to develop tools to help clinicians identify those patients who will benefit from chemotherapy at the end of life. Abstract New treatment options in cancer have resulted in increased use of health care resources near the end of life. We assessed health care use near the end of life of patients with advanced breast cancer (ABC). From the Southeast Netherlands Breast cancer (SONABRE) registry, we selected all deceased patients diagnosed with ABC in Maastricht University Medical Center between January 2007 and October 2017. Frequency of health care use in the last six months of life was described and predictors for health care use were assessed. Of 203 patients, 76% were admitted during the last six months, 6% to the intensive care unit (ICU) and 2% underwent cardiopulmonary resuscitation (CPR). Death in hospital occurred in 25%. Nine percent of patients received a new line of chemotherapy ≤30 days before death, which was associated with age <65 years and <1 year survival since diagnosis of metastases. In these patients, the hospital admission rate was 95%, of which 79% died in the hospital, mostly due to progressive disease (80%). In conclusion, the frequency of ICU-admission, CPR or a new line of chemotherapy ≤30 days before death was low. Most patients receiving a new line of chemotherapy ≤30 days before death, died in the hospital.
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Ortiz-Ortiz KJ, Tortolero-Luna G, Torres-Cintrón CR, Zavala-Zegarra DE, Gierbolini-Bermúdez A, Ramos-Fernández MR. High-Intensity End-of-Life Care Among Patients With GI Cancer in Puerto Rico: A Population-Based Study. JCO Oncol Pract 2021; 17:e168-e177. [PMID: 33567240 PMCID: PMC8202061 DOI: 10.1200/op.20.00541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
High-intensity care with undue suffering among patients with cancer at the end of life (EoL) is associated with poor quality of life. We examined the pattern and predictors of high-intensity care among patients with GI cancer in Puerto Rico.
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Affiliation(s)
- Karen J Ortiz-Ortiz
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico.,Department of Health Services Administration, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Guillermo Tortolero-Luna
- Division of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Carlos R Torres-Cintrón
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Diego E Zavala-Zegarra
- Puerto Rico Central Cancer Registry, University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Axel Gierbolini-Bermúdez
- Department of Social Science, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - María R Ramos-Fernández
- Department of Emergency Medicine, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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11
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Fond G, Pauly V, Duba A, Salas S, Viprey M, Baumstarck K, Orleans V, Llorca PM, Lancon C, Auquier P, Boyer L. End of life breast cancer care in women with severe mental illnesses. Sci Rep 2021; 11:10167. [PMID: 33986419 PMCID: PMC8119688 DOI: 10.1038/s41598-021-89726-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 04/16/2021] [Indexed: 11/30/2022] Open
Abstract
Little is known on the end-of-life (EOL) care of terminal breast cancer in women with severe psychiatric disorder (SPD). The objective was to determine if women with SPD and terminal breast cancer received the same palliative and high-intensity care during their end-of-life than women without SPD. Study design, setting, participants. This population-based cohort study included all women aged 15 and older who died from breast cancer in hospitals in France (2014–2018). Key measurements/outcomes. Indicators of palliative care and high-intensity EOL care. Multivariable models were performed, adjusted for age at death, year of death, social deprivation, duration between cancer diagnosis and death, metastases, comorbidity, smoking addiction and hospital category. The analysis included 1742 women with SPD (287 with bipolar disorder, 1075 with major depression and 380 with schizophrenia) and 36,870 women without SPD. In multivariate analyses, women with SPD had more palliative care (adjusted odd ratio aOR 1.320, 95%CI [1.153–1.511], p < 0.001), longer palliative care follow-up before death (adjusted beta = 1.456, 95%CI (1.357–1.555), p < 0.001), less chemotherapy, surgery, imaging/endoscopy, and admission in emergency department and intensive care unit. Among women with SPD, women with bipolar disorders and schizophrenia died 5 years younger than those with recurrent major depression. The survival time was also shortened in women with schizophrenia. Despite more palliative care and less high-intensity care in women with SPD, our findings also suggest the existence of health disparities in women with bipolar disorders and schizophrenia compared to women with recurrent major depression and without SPD. Targeted interventions may be needed for women with bipolar disorders and schizophrenia to prevent these health disparities.
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Affiliation(s)
- Guillaume Fond
- Faculté de Médecine - Secteur Timone, EA 3279: CEReSS -Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille Univ., 27 Boulevard Jean Moulin, 13005, Marseille, France. .,Department of Epidemiology and Health Economics, APHM, Marseille, France. .,Department of Medical Information, APHM, Marseille, France.
| | - Vanessa Pauly
- Faculté de Médecine - Secteur Timone, EA 3279: CEReSS -Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille Univ., 27 Boulevard Jean Moulin, 13005, Marseille, France.,Department of Medical Information, APHM, Marseille, France
| | - Audrey Duba
- Faculté de Médecine - Secteur Timone, EA 3279: CEReSS -Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille Univ., 27 Boulevard Jean Moulin, 13005, Marseille, France.,Department of Epidemiology and Health Economics, APHM, Marseille, France.,Department of Medical Information, APHM, Marseille, France
| | | | - Marie Viprey
- Faculté de Médecine - Secteur Timone, EA 3279: CEReSS -Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille Univ., 27 Boulevard Jean Moulin, 13005, Marseille, France.,Department of Epidemiology and Health Economics, APHM, Marseille, France
| | - Karine Baumstarck
- Faculté de Médecine - Secteur Timone, EA 3279: CEReSS -Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille Univ., 27 Boulevard Jean Moulin, 13005, Marseille, France
| | | | | | - Christophe Lancon
- Faculté de Médecine - Secteur Timone, EA 3279: CEReSS -Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille Univ., 27 Boulevard Jean Moulin, 13005, Marseille, France.,Department of Psychiatry, APHM, Marseille, France
| | - Pascal Auquier
- Faculté de Médecine - Secteur Timone, EA 3279: CEReSS -Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille Univ., 27 Boulevard Jean Moulin, 13005, Marseille, France.,Department of Epidemiology and Health Economics, APHM, Marseille, France
| | - Laurent Boyer
- Faculté de Médecine - Secteur Timone, EA 3279: CEReSS -Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, Aix-Marseille Univ., 27 Boulevard Jean Moulin, 13005, Marseille, France.,Department of Epidemiology and Health Economics, APHM, Marseille, France.,Department of Medical Information, APHM, Marseille, France
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12
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Tanguy-Melac A, Denis P, Fagot-Campagna A, Gastaldi-Ménager C, Laurent M, Tuppin P. Intensity of Care, Expenditure, and Place of Death in French Women in the Year Before Their Death From Breast Cancer: A Population-Based Study. Cancer Control 2020; 27:1073274820977175. [PMID: 33356850 PMCID: PMC8480356 DOI: 10.1177/1073274820977175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Health care utilization of women with breast cancer (BC) during the last year of life, together with the causes and place of death and associated expenditure have been poorly described. Women treated for BC (2014-2015) with BC as a cause of death in 2015 and covered by the national health insurance general scheme (77% of the population) were identified in the French health data system (n = 6,696, mean age: 68.7 years, SD ± 15). Almost 70% died in short-stay hospitals (SSH), 4% in hospital-at-home (HaH), 9% in Rehab, 5% in skilled nursing homes (SNH) and 12% at home. One-third presented cardiovascular comorbidity. During the last year, 90% were hospitalized at least once in SSH, 25% in Rehab, 13% in HaH and 71% received hospital palliative care (HPC), but only 5% prior to their end-of-life stay. During the last month, 85% of women were admitted at least once to a SSH, 42% via the emergency department, 10% to an ICU, 24% received inpatient chemotherapy and 18% received outpatient chemotherapy. Among the 83% of women who died in hospital, independent factors for HPC use were cardiovascular comorbidity (adjusted odds ratio, aOR: 0.83; 95%CI: 0.72-0.95) and, in the 30 days before death, at least one SNH stay (aOR: 0.52; 95%CI: 0.36-0.76), ICU stay (aOR: 0.36; 95%CI: 0.30-0.43), inpatient chemotherapy (aOR: 0.55; 95%CI: 0.48-0.63), outpatient chemotherapy (aOR: 0.60; 95%CI: 0.51-0.70), death in Rehab (aOR: 1.4; 95%CI: 1.05-1.86) or HAH (aOR: 4.5; 95%CI: 2.47-8.1) vs SSH. Overall mean expenditure reimbursed per woman was €38,734 and €42,209 for those with PC. Women with inpatient or outpatient chemotherapy during the last month had lower rates of HPC, suggesting declining use of HPC before death. This study also indicates SSH-centered management with increased use of HPC in HaH and Rehab units and decreased access to HPC in SNH.
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Affiliation(s)
| | - Pierre Denis
- 27054Caisse Nationale d'Assurance Maladie (CNAM), Paris, France
| | | | | | | | - Philippe Tuppin
- 27054Caisse Nationale d'Assurance Maladie (CNAM), Paris, France
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13
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Kadakia KC, Trufan SJ, Jagosky MH, Worrilow WM, Harrison BW, Broyhill KL, Hwang JJ, Musselwhite LW, Aktas A, Walsh D, Salem ME. Early-onset pancreatic cancer: an institutional series evaluating end-of-life care. Support Care Cancer 2020; 29:3613-3622. [PMID: 33170401 DOI: 10.1007/s00520-020-05876-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/02/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Little is known about the use of palliative and hospice care and their impact on healthcare utilization near the end of life (EOL) in early-onset pancreatic cancer (EOPC). METHODS Patients with EOPC (≤ 50 years) were identified using the institutional tumor registry for years 2011-2018, and demographic, clinical, and rates of referral to palliative and hospice services were obtained retrospectively. Predictors of healthcare utilization, defined as use of ≥ 1 emergency department (ED) visit or hospitalization within 30 days of death, place of death (non-hospital vs. hospital), and time from last chemotherapy administration prior to death, were assessed using descriptive, univariable, and multivariable analyses including chi-square and logistic regression models. RESULTS A total of 112 patients with EOPC with a median age of 46 years (range, 29-50) were studied. Forty-four percent were female, 28% were Black, and 45% had metastatic disease. Fifty-seven percent received palliative care at a median of 7.8 weeks (range 0-265) following diagnosis. The median time between last chemotherapy and death was 7.9 weeks (range 0-102). Seventy-four percent used hospice services prior to death for a median of 15 days (range 0-241). Rate of healthcare utilization at the EOL was 74% in the overall population. Black race and late use of chemotherapy were independently associated with increase in ED visits/hospitalization and hospital place of death. CONCLUSIONS Although we observed early referrals to palliative care among patients with newly diagnosed EOPC, short duration of hospice enrollment and rates of healthcare utilization prior to death were substantial.
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Affiliation(s)
- Kunal C Kadakia
- Gastrointestinal Medical Oncology, Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, NC, 28204, Charlotte, USA. .,Department of Supportive Oncology, Levine Cancer Institue, Atrium Health, NC, Charlotte, USA.
| | - Sally J Trufan
- Department of Cancer Biostatistics, Levine Cancer Institue, Atrium Health, NC, Charlotte, USA
| | - Megan H Jagosky
- Gastrointestinal Medical Oncology, Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, NC, 28204, Charlotte, USA
| | - William M Worrilow
- Gastrointestinal Medical Oncology, Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, NC, 28204, Charlotte, USA
| | - Bradley W Harrison
- Gastrointestinal Medical Oncology, Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, NC, 28204, Charlotte, USA
| | - Katherine L Broyhill
- Department of Genetics, Levine Cancer Institue, Atrium Health, NC, Charlotte, USA
| | - Jimmy J Hwang
- Gastrointestinal Medical Oncology, Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, NC, 28204, Charlotte, USA
| | - Laura W Musselwhite
- Gastrointestinal Medical Oncology, Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, NC, 28204, Charlotte, USA
| | - Aynur Aktas
- Department of Supportive Oncology, Levine Cancer Institue, Atrium Health, NC, Charlotte, USA
| | - Declan Walsh
- Department of Supportive Oncology, Levine Cancer Institue, Atrium Health, NC, Charlotte, USA
| | - Mohamed E Salem
- Gastrointestinal Medical Oncology, Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, NC, 28204, Charlotte, USA
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14
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Ferrario A, Xu X, Zhang F, Ross-Degnan D, Wharam JF, Wagner AK. Intensity of End-of-Life Care in a Cohort of Commercially Insured Women With Metastatic Breast Cancer in the United States. JCO Oncol Pract 2020; 17:e194-e203. [PMID: 33170746 DOI: 10.1200/op.20.00089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE There is limited evidence on the intensity of end-of-life (EOL) care for women < 65 years old, who account for about 40% of breast cancer deaths in the United States. Using established indicators, we estimated the intensity of EOL care among these women. METHODS We used 2000-2014 claims data from a large US insurer to identify women with metastatic breast cancer who, in the last month of their lives, had more than one hospital admission, emergency department visit, or an intensive care unit (ICU) admission and/or used antineoplastic therapy in the last 14 days of life. Using multivariate logistic regression, we assessed whether intensity of EOL care differed by demographic characteristics, socioeconomic factors, or regions. RESULTS Adjusted estimates show an increase in EOL ICU admissions between 2000-2003 and 2010-2014 from 14% (95% CI, 10% to 17%) to 23% (95% CI, 20% to 26%) and a small increase in emergency department visits from 10% (95% CI, 7% to 13%) to 12% (95% CI, 9% to 15%), both statistically significant. There was no statistically significant change in the proportions of women experiencing more than one EOL hospitalization (14% in 2010-2014; 95% CI, 11% to 17%) and of those receiving EOL antineoplastic treatment (24% in 2010-2014; 95% CI, 21% to 27%). Living in predominantly mixed, Hispanic, Black, or Asian neighborhoods correlated with more intense care (odds ratio, 1.39; 95% CI, 1.10 to 1.77 for ICU). CONCLUSION Consistent with findings in the Medicare population, our results suggest an overall increase in the number of ICU admissions at the EOL over time. They also suggest that patients from non-White neighborhoods receive more intense acute care.
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Affiliation(s)
| | - Xin Xu
- Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, MA
| | - Fang Zhang
- Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, MA
| | - Dennis Ross-Degnan
- Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, MA
| | - J Frank Wharam
- Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, MA
| | - Anita K Wagner
- Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, MA
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15
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Dalhammar K, Malmström M, Schelin M, Falkenback D, Kristensson J. The impact of initial treatment strategy and survival time on quality of end-of-life care among patients with oesophageal and gastric cancer: A population-based cohort study. PLoS One 2020; 15:e0235045. [PMID: 32569329 PMCID: PMC7307755 DOI: 10.1371/journal.pone.0235045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/10/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Oesophageal and gastric cancer are highly lethal malignancies with a 5-year survival rate of 15-29%. More knowledge is needed about the quality of end-of-life care in order to understand the burden of the illness and the ability of the current health care system to deliver timely and appropriate end-of-life care. The aim of this study was to describe the impact of initial treatment strategy and survival time on the quality of end-of-life care among patients with oesophageal and gastric cancer. METHODS This register-based cohort study included patients who died from oesophageal and gastric cancer in Sweden during 2014-2016. Through linking data from the National Register for Esophageal and Gastric Cancer, the National Cause of Death Register, and the Swedish Register of Palliative Care, 2156 individuals were included. Associations between initial treatment strategy and survival time and end-of-life care quality indicators were investigated. Adjusted risk ratios (RRs) with 95% confidence intervals were calculated using modified Poisson regression. RESULTS Patients with a survival of ≤3 months and 4-7 months had higher RRs for hospital death compared to patients with a survival ≥17 months. Patients with a survival of ≤3 months also had a lower RR for end-of-life information and bereavement support compared to patients with a survival ≥17 months, while the risks of pain assessment and oral assessment were not associated with survival time. Compared to patients with curative treatment, patients with no tumour-directed treatment had a lower RR for pain assessment. No significant differences were shown between the treatment groups regarding hospital death, end-of-life information, oral health assessment, and bereavement support. CONCLUSIONS Short survival time is associated with several indicators of low quality end-of-life care among patients with oesophageal and gastric cancer, suggesting that a proactive palliative care approach is imperative to ensure quality end-of-life care.
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Affiliation(s)
- Karin Dalhammar
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Marlene Malmström
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Maria Schelin
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Dan Falkenback
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - Jimmie Kristensson
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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16
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Chemotherapy use near the end-of-life in patients with metastatic breast cancer. Breast Cancer Res Treat 2020; 181:645-651. [PMID: 32383058 PMCID: PMC7220858 DOI: 10.1007/s10549-020-05663-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/29/2020] [Indexed: 11/24/2022]
Abstract
Introduction Very few data are available regarding the use of chemotherapy in patients with metastatic breast cancer (MBC) near the end-of-life, i.e., the final month. The aim of this study was to provide a descriptive analysis of its use in two different European geographic areas (Sweden and Greece). Materials and methods We retrospectively collected data regarding clinicopathologic characteristics, survival, and use of chemotherapy during the final 30 days of life using two sources: for the Swedish cohort, patients who were diagnosed with MBC in 2010–2015 were identified from the Stockholm-Gotland population-based Breast Cancer Registry and treatment data were collected using hospital charts. For the Greek cohort, patients with MBC were identified from hospital charts at two hospitals in Athens and Crete. Results In the Swedish cohort, 1571 patients were identified; median overall survival was 16.96 months (95% CI 15.4–18.4). 23.2% of patients were treated with chemotherapy during the final month of life, with higher rates among patients ≤ 60 years (p < 0.001). Per OS monotherapy such as capecitabine or vinorelbine was most commonly used. In contrast, median OS in the Greek cohort (n = 966) was 49.8 months (95% CI 45.6–54.1) and 46.5% of patients received chemotherapy at the end-of-life, most commonly intravenous drug combinations. In multivariable analysis, age and albumin levels were statistically significantly associated with chemotherapy use in the Swedish cohort. Conclusion Chemotherapy use near the end-of-life was common, which might negatively impact patient quality of life. Electronic supplementary material The online version of this article (10.1007/s10549-020-05663-w) contains supplementary material, which is available to authorized users.
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17
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Paredes AZ, Hyer JM, Tsilimigras DI, Mehta R, Sahara K, White S, Dillhoff ME, Ejaz A, Cloyd JM, Pawlik TM. Hospice utilization among Medicare beneficiaries dying from pancreatic cancer. J Surg Oncol 2019; 120:624-631. [PMID: 31290170 DOI: 10.1002/jso.25623] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 06/21/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Use of hospice services among patients with pancreatic cancer following pancreatic resection remains unknown. METHODS Patients with pancreatic cancer who underwent resection were identified in the Medicare Standard Analytic Files. Outcomes included overall hospice use, early hospice enrollment (≥4 weeks before death), late hospice enrollment (initiation within 3 days of death), and Medicare expenditures. RESULTS Among the 4369 deceased individuals, three-fourths of patients (n = 3252, 74.4%) used hospice at the time of death. Patients who did not use hospice were more likely to be male, have a complication on index admission and receive life sustaining treatments on subsequent admissions (P < .05). Only one-third (32.2%) of patients initiated hospice services early. Medicare expenditure during the last month of life was $10 000 lower among patients who initialized hospice services at least 1 month before death versus within 3 days of death (late: $10 581 [$5454-$17 200], early: $221 [$46-$733]; P < .001) CONCLUSION: While three-fourths of patients utilized hospice services after pancreatic resection, only one-third of patients initiated hospice services at least one-month before death. Late hospice use was associated with higher Medicare expenditures during the last month of life. Further research is needed to understand barriers to early hospice utilization.
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Affiliation(s)
- Anghela Z Paredes
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio.,Division of Health Information Management and Systems, The Ohio State Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - J Madison Hyer
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio.,Division of Health Information Management and Systems, The Ohio State Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Diamantis I Tsilimigras
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio.,Division of Health Information Management and Systems, The Ohio State Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Rittal Mehta
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio.,Division of Health Information Management and Systems, The Ohio State Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Kota Sahara
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio.,Division of Health Information Management and Systems, The Ohio State Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Susan White
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio.,Division of Health Information Management and Systems, The Ohio State Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Mary E Dillhoff
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio.,Division of Health Information Management and Systems, The Ohio State Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Aslam Ejaz
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio.,Division of Health Information Management and Systems, The Ohio State Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Jordan M Cloyd
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio.,Division of Health Information Management and Systems, The Ohio State Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Timothy M Pawlik
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio.,Division of Health Information Management and Systems, The Ohio State Wexner Medical Center, The Ohio State University, Columbus, Ohio
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18
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Abstract
PURPOSE OF REVIEW Breast cancer incidence and mortality increase with age. Older patients (≥ 70) are often excluded from studies. Due to multiple factors, it is unclear whether this population is best-treated using standard guidelines. Here, we review surgical management in older women with breast cancer. RECENT FINDINGS Geriatric assessments can guide treatment recommendations and aid in predicting survival and quality of life. Surgery remains a principal component of breast cancer treatment in older patients, though differences exist compared with younger women, including higher mastectomy rates and evidence-based support of omission of post-lumpectomy radiation or axillary dissection in subsets of patients. In those forgoing surgical management, there is increased use of endocrine therapy. Hospice is also a valuable element of end-of-life care. Physicians should utilize geriatric assessment to make treatment recommendations for older breast cancer patients, including omission of radiation therapy, alterations to standard surgeries, or enrollment in hospice care.
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19
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Fang P, Jagsi R, He W, Lei X, Campbell EG, Giordano SH, Smith GL. Rising and Falling Trends in the Use of Chemotherapy and Targeted Therapy Near the End of Life in Older Patients With Cancer. J Clin Oncol 2019; 37:1721-1731. [PMID: 31141431 DOI: 10.1200/jco.18.02067] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE End-of-life (EOL) chemotherapy has been described as the most widespread, wasteful, and unnecessary practice in oncology, with benchmarking aimed to reduce physician use of chemotherapy within 14 days of EOL. We evaluated the recent transformation of EOL chemotherapy and targeted therapy practices nationally. METHODS In patients older than 65 years of age who died as a result of breast (n = 19,887), lung (n = 79,613), colorectal (n = 29,844), or prostate (n = 17,910) cancer between 2007 and 2013, we evaluated the guideline-benchmarked measure of chemotherapy use within 14 days of EOL in SEER-Medicare. Comparison outcomes were nonbenchmarked measures of chemotherapy and targeted therapy across time points within 6 months of EOL. Cochran-Armitage test was used to evaluate temporal trends. Multilevel logistic models and intraclass correlation coefficient was used to evaluate variation in EOL chemotherapy use at the physician level. RESULTS From 2007 to 2013, chemotherapy within 14 days of EOL declined from 6.7% to 4.9% of patients (Ptrend < .001; ∆ = -1.8%). Similar declines occurred for chemotherapy within 1 month (Ptrend < .001; ∆ = -1.8%) and 2 months (Ptrend < .001; ∆ = -1.3%) of EOL. In contrast, chemotherapy within 4 to 6 months of EOL rose (Ptrend ≤ .04; ∆ = 0.7% to 1.7%), and 43.0% of all patients received chemotherapy within 6 months of EOL. Frequency of targeted therapy use across all time points within 6 months of EOL was stable to marginally rising from 2007 to 2013 (Ptrend = .09 to .82; ∆ = -0.2% to 1.8%); overall, 1.2% received targeted therapy within 14 days and 3.6% within 1 month of EOL. By 2013, 13.2% of patients received any targeted therapy within 6 months of EOL. In a multilevel model, 5.19% (intraclass correlation coefficient) of variation in 14-day EOL chemotherapy was attributed to the physician level. CONCLUSION With national benchmarking, chemotherapy within 14 days of EOL successfully declined to less than 5%, with comprehensive benchmark uptake by physicians. Results may inform current strategies to help to achieve high-value EOL oncology practice.
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Affiliation(s)
- Penny Fang
- 1 The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Weiguo He
- 1 The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xiudong Lei
- 1 The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Grace L Smith
- 1 The University of Texas MD Anderson Cancer Center, Houston, TX
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20
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Nipp RD, Tramontano AC, Kong CY, Hur C. Patterns and predictors of end-of-life care in older patients with pancreatic cancer. Cancer Med 2018; 7:6401-6410. [PMID: 30426697 PMCID: PMC6308041 DOI: 10.1002/cam4.1861] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Little is known about end-of-life care among patients with pancreatic adenocarcinoma (PDAC). We used the Surveillance, Epidemiology, and End Results-Medicare linked database to analyze patterns of hospice use and end-of-life treatment in patients with PDAC. METHODS We included patients diagnosed with PDAC between 2000-2011 and who had died by December 31, 2012. We assessed patterns of hospice use, chemotherapy receipt, and intensive care unit (ICU) admissions at end-of-life. We used multivariable logistic regression to investigate predictors of end-of-life care. RESULTS In our cohort of 16 309 patients, 70.5% enrolled in hospice, of which 29.1% enrolled in the last 7 days of life. Use of hospice increased over time, from 61.6% in 2000 to 77.5% in 2012 (P-value for trend <0.0001). Among the entire cohort, 6.4% received chemotherapy within the last 14 days of life and 13.1% were admitted to the ICU within the last 30 days of life. Late ICU admissions increased over time, while chemotherapy receipt at the end-of-life decreased. Patients who were older, female, with higher SES, or from the South or Midwest were more likely to enroll in hospice. Those who were younger or male were more likely to receive chemotherapy or have an ICU admission at the end-of-life. CONCLUSION Although hospice enrollment has increased among patients with PDAC, late enrollment still occurs in a substantial proportion of patients. While chemotherapy at the end-of-life has decreased slightly, ICU admissions at the end-of-life have continued to increase. Further research is needed to determine effective ways of enhancing end-of-life care for patients with PDAC.
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Affiliation(s)
- Ryan D Nipp
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Angela C Tramontano
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
| | - Chung Yin Kong
- Harvard Medical School, Boston, Massachusetts.,Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
| | - Chin Hur
- Harvard Medical School, Boston, Massachusetts.,Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
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Tramontano AC, Nipp R, Kong CY, Yerramilli D, Gainor JF, Hur C. Hospice use and end-of-life care among older patients with esophageal cancer. Health Sci Rep 2018; 1:e76. [PMID: 30623099 PMCID: PMC6266462 DOI: 10.1002/hsr2.76] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/07/2018] [Accepted: 06/18/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Hospice and end-of-life health care utilization among patients with esophageal cancer are understudied. We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to analyze hospice use and end-of-life treatment patterns. METHODS We included patients diagnosed with esophageal adenocarcinoma or squamous cell carcinoma between 2000 and 2011 and who had died by December 31, 2013. We evaluated patterns of hospice enrollment, chemotherapy receipt, radiation receipt, acute care hospitalizations, and intensive care unit (ICU) admissions at end of life. We used multivariate logistic regression to evaluate possible associations with hospice use, late ICU admission, and late chemotherapy receipt. RESULTS Our study included 6449 patients; 3597 (55.8%) enrolled in hospice. Among hospice enrolled patients, 31.4% enrolled in the last 7 days of life. Hospice enrollment increased over time, from 43.2% in 2000 to 59.6% in 2013. Patients who were older, female, with stage IV disease, or those with higher socioeconomic status were more likely to enroll in hospice. Among all patients, 19.1% had an ICU admission within the last 30 days and 4.6% received chemotherapy within the last 14 days of life. Those who were Black or Asian (compared to White), married, or had a comorbidity score >1 were more likely to have a late ICU admission. Males and younger patients were more likely to receive chemotherapy at end of life. CONCLUSION Hospice enrollment rates among patients with esophageal cancer have increased over time; however, a significant percentage of patients enrolls near the end of life. Further research is needed to improve understanding of how end-of-life care decisions for these patients are made.
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Affiliation(s)
| | - Ryan Nipp
- Department of Medicine, Division of Hematology and OncologyMassachusetts General Hospital Cancer Center & Harvard Medical SchoolBostonMAUSA
| | - Chung Yin Kong
- Institute for Technology AssessmentMassachusetts General HospitalBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | - Divya Yerramilli
- Department of Radiation OncologyMassachusetts General HospitalBostonMAUSA
| | - Justin F. Gainor
- Department of Medicine, Division of Hematology and OncologyMassachusetts General Hospital Cancer Center & Harvard Medical SchoolBostonMAUSA
| | - Chin Hur
- Institute for Technology AssessmentMassachusetts General HospitalBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
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