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Hirooka K, Okumura Y, Matsumoto S, Fukahori H, Ogawa A. Quality of End-of-Life in Cancer Patients With Dementia: Using A Nationwide Inpatient Database. J Pain Symptom Manage 2022; 64:1-7. [PMID: 35367609 DOI: 10.1016/j.jpainsymman.2022.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 12/27/2022]
Abstract
CONTEXT The growing number of older people significantly affects end-of-life care. However, few studies have assessed the quality of end-of-life care among cancer patients with dementia. OBJECTIVES To assess the quality of end-of-life care among non-small cell lung cancer patients with or without dementia using a nationwide inpatient database from Japan. METHODS This was a retrospective observational study that used a nationwide inpatient database of 366 acute care hospitals from April 2014 to November 2018. Poisson regression models were used where the quality indicator was the dependent variable, dementia status was the independent variable, and the age group and Charlson comorbidity index were covariates. Incidence proportion ratios (IPRs) and confidence intervals (CIs) were obtained from the model. RESULTS The study population included 16,758 patients, of whom 4507 (26.9%) had dementia. The incidence proportion of opioid use (61.8% vs. 70.8%; IPR: 0.87, 95% CI: 0.83-0.91), palliative care consultation (2.7% vs. 3.8%; IPR: 0.71, 95% CI: 0.58-0.88), mechanical ventilation (4.0% vs. 5.4%; IPR: 0.74, 95% CI: 0.62-0.87), and cardiopulmonary resuscitation (2.2% vs. 2.8%; IPR: 0.79, 95% CI: 0.63-0.99) was significantly lower in patients with dementia than in those without dementia. CONCLUSION Patients with dementia are less likely to receive end-of-life care. This study demonstrates the importance of providing high-quality end-of-life care regardless the cognitive status of patients with cancer.
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Affiliation(s)
- Kayo Hirooka
- Department of Home Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan (K.H.)
| | - Yasuyuki Okumura
- Initiative for Clinical Epidemiological Research, Tokyo, Japan (Y.O.).
| | - Sachiko Matsumoto
- Department of Gerontological Nursing, Japanese Red Cross College of Nursing, Faculty of Nursing at Saitama, Saitama, Japan (S.M.)
| | - Hiroki Fukahori
- Division of Gerontological Nursing, Faculty of Nursing and Medical Care, Keoi University, Kanagawa, Japan (H.F.)
| | - Asao Ogawa
- Psycho Oncology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa-shiChiba, Japan (A.O.)
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Hiratsuka Y, Oishi T, Miyashita M, Morita T, Mack JW, Sato Y, Takahashi M, Komine K, Saijo K, Ishioka C, Inoue A. Factors related to specialized palliative care use and aggressive care at end of life in Japanese patients with advanced solid cancers: a cohort study. Support Care Cancer 2021; 29:7805-7813. [PMID: 34169330 DOI: 10.1007/s00520-021-06364-w] [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: 04/01/2021] [Accepted: 06/09/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to (1) describe characteristics of aggressive care at the end of life (EOL) and (2) identify factors associated with specialized palliative care use (SPC) and aggressive care at the EOL among Japanese patients with advanced cancer. METHODS This single-center, follow-up cohort study involved patients with advanced cancer who received chemotherapy at Tohoku University Hospital. Patients were surveyed at enrollment, and we followed clinical events for 5 years from enrollment in the study. We performed multivariate logistic regression analysis to identify independent factors related to SPC use and chemotherapy in the last month before death. RESULTS We analyzed a total of 135 patients enrolled between January 2015 and January 2016. No patients were admitted to the intensive care unit, and few received resuscitation or ventilation. We identified no factors significantly associated with SPC use. Meanwhile, younger age (20-59 years, odds ratio [OR] 4.10; 95% confidence interval [CI] 1.30-12.91; p = 0.02) and no receipt of SPC (OR 4.32; 95% CI 1.07-17.37; p = 0.04) were associated with chemotherapy in the last month before death. CONCLUSION Younger age and a lack of SPC were associated with chemotherapy at the EOL in patients with advanced cancer in Japan. These findings suggest that Japanese patients with advanced cancer may benefit from access to SPC.
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Affiliation(s)
- Yusuke Hiratsuka
- Department of Palliative Medicine, Takeda General Hospital, Aizu Wakamatsu, Japan.,Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Takayuki Oishi
- Department of Clinical Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan.
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Jennifer W Mack
- Department of Pediatric Oncology and Center for Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Yuko Sato
- Department of Clinical Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Masahiro Takahashi
- Department of Clinical Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Keigo Komine
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan
| | - Ken Saijo
- Department of Clinical Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Chikashi Ishioka
- Department of Clinical Oncology, Tohoku University School of Medicine, Sendai, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
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Park SJ, Nam EJ, Chang YJ, Lee YJ, Jho HJ. Factors Related with Utilizing Hospice Palliative Care Unit among Terminal Cancer Patients in Korea between 2010 and 2014: a Single Institution Study. J Korean Med Sci 2018; 33:e263. [PMID: 30288159 PMCID: PMC6170669 DOI: 10.3346/jkms.2018.33.e263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 07/13/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Establishing and designating specialized hospice palliative care units (HPCUs) has been an important part of national policy to promote hospice palliative care in Korea in the recent decade. However, few studies have sought to identify patterns and barriers for utilizing HPCU over the period of national policy implementation. We aimed to investigate factors related with utilizing HPCU for terminal cancer patients after consultation with a palliative care team (PCT). METHODS We reviewed medical records for 1,028 terminal cancer patients who were referred to the PCT of the National Cancer Center in 2010 and 2014. We compared the characteristics of the patients who decided to utilize HPCU and those who did not. We also analyzed factors influencing choices for a medical institution and reasons for not selecting an HPCU. RESULTS The patients' mean age was 61.0 ± 12.2, with lung cancer patients (24.3%) comprising the largest percentage of these patients. The percentage of referred patients who utilized an HPCU was 53.9% in 2014, increasing from 44.6% in 2010. Older age and awareness of terminal illness were found to be positively associated with utilization of an HPCU. The most common reason for not selecting an HPCU was "refusing hospice facility" (34.9%), followed by "near death," "poor accessibility to an HPCU," and "caregiving problems." CONCLUSION Compared to 2010, HPCU utilization by terminal cancer patients increased in 2014. Improving awareness of terminal condition among patients and family members and earlier discussion of end-of-life care would be important to promote utilization of HPCU.
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Affiliation(s)
- So-Jung Park
- Department of Hospice & Palliative Service, Hospital, National Cancer Center, Goyang, Korea
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eun Jeong Nam
- Department of Hospice & Palliative Service, Hospital, National Cancer Center, Goyang, Korea
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Yoon Jung Chang
- Department of Hospice & Palliative Service, Hospital, National Cancer Center, Goyang, Korea
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Yong-Jae Lee
- Department of Family Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Hyun Jung Jho
- Department of Hospice & Palliative Service, Hospital, National Cancer Center, Goyang, Korea
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
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Chiang JK, Kao YH. Predictors of high healthcare costs in elderly patients with liver cancer in end-of-life: a longitudinal population-based study. BMC Cancer 2017; 17:568. [PMID: 28836965 PMCID: PMC5571574 DOI: 10.1186/s12885-017-3561-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/17/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Studies have indicated a pervasive pattern of decreasing healthcare costs during elderly patients' last year of life. The aim of this study was to explore the predictors of high healthcare costs (HC) in elderly liver cancer patients in Taiwan during their last month of life (LML). METHODS Costs of hospitalization, outpatient visits, aggressiveness of care, and associated costs for elderly (age ≥ 65 y) patients with liver cancer in the LML were analyzed using a national insurance database. An HC was defined as being greater than the 90th percentile (US $5093) in the LML, amounting to 38.95% of total healthcare costs. RESULTS We enrolled 2121 subjects who died during 1997-2011. Mean healthcare costs per person in their LML were US $8042 ± 3477 in the HC group and US $1407 ± 1464 in the non-HC group (p < 0.001). For patients receiving aggressive end-of-life (EOL) cancer care (e.g. intensive care, cardiopulmonary resuscitation, anticancer treatment, and a high number of admission days), comorbidities of chronic kidney disease, esophageal bleeding, and receiving opioids in the LML, were significantly independent positive predictors of HCs; but admission times, comorbidities of ascites, and hypertension were negative predictors. CONCLUSION These findings could inform healthcare providers by avoiding aggressive treatments during EOL for elderly patients with liver cancer and to save on healthcare costs. Shorter admission days and more admission times in the last month of life could decrease healthcare costs.
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Affiliation(s)
- Jui-Kun Chiang
- Department of Family Medicine, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan
| | - Yee-Hsin Kao
- Department of Family Medicine, Tainan Municipal Hospital, 670 Chung-Te Road, Tainan, 701, Taiwan.
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Sheng J, Zhang YX, He XB, Fang WF, Yang YP, Lin GN, Wu X, Li N, Zhang J, Zhai LZ, Zhao YY, Huang Y, Zhou NN, Zhao HY, Zhang L. Chemotherapy Near the End of Life for Chinese Patients with Solid Malignancies. Oncologist 2016; 22:53-60. [PMID: 27789776 DOI: 10.1634/theoncologist.2016-0013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 08/23/2016] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION There are increasing concerns about the negative impacts of chemotherapy near the end of life (EOL). There is discrepancy among different countries about its use, and little is known about the real-world situation in China. PATIENTS AND METHODS This retrospective study was conducted at six representative hospitals across China. Adult decedents with a record of advanced solid cancer and palliative chemotherapy were consecutively screened from 2010 through 2014. The prevalence of EOL chemotherapy within the last 1 month of life was set as the primary outcome. The correlations among EOL chemotherapy, clinicopathological features, and overall survival (OS) were investigated. RESULTS A total of 3,350 decedents who had had cancer were consecutively included; 2,098 (62.6%) were male and the median age was 56 years (range, 20-88). There were 177 (5.3%), 387 (11.6%), and 837 (25.0%) patients who received EOL chemotherapy within the last 2 weeks, 1 month, and 2 months of life, respectively. We identified inferior OS (median OS, 7.1 vs. 14.2 months; hazard ratio, 1.37; 95% confidence interval [CI], 1.23-1.53; p < .001), more intensive treatments (e.g., admitted to intensive care unit [ICU] in the last month of life, received cardiopulmonary resuscitation and invasive ventilation support), and hospital death (odds ratio, 1.53; 95% CI, 1.14-2.06; p = .005) among patients who received continued chemotherapy within the last month compared with those who did not. However, subgroup analyses indicated that receiving oral agents correlated with fewer ICU admissions and lower rates of in-hospital death. CONCLUSION This study showed that EOL chemotherapy is commonly used in China. Intravenous chemotherapy at the EOL significantly correlated with poor outcomes and the role of oral anticancer agents warrants further investigation. The Oncologist 2017;22:53-60Implications for Practice: The role of chemotherapy toward the end of life (EOL) in patients with solid cancers is debatable. This article is believed to be the first to report the current prevalence of EOL chemotherapy in China. This study found that, compared with oral anticancer agents, intravenous chemotherapy at the EOL was significantly associated with poor outcomes. Therefore, the role of oral anticancer agents at the EOL stage deserves further investigation.
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Affiliation(s)
- Jin Sheng
- Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Ya-Xiong Zhang
- Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Xiao-Bo He
- Department of Radiotherapy, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Wen-Feng Fang
- Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Yun-Peng Yang
- Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Gui-Nan Lin
- Department of Medical Oncology, Zhongshan City People's Hospital, Zhongshan, People's Republic of China
| | - Xuan Wu
- Department of Medical Oncology, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China
| | - Ning Li
- Department of Medical Oncology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
- Henan Cancer Hospital, Zhengzhou, People's Republic of China
| | - Jing Zhang
- Department of Medical Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Lin-Zhu Zhai
- Department of Medical Oncology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
| | - Yuan-Yuan Zhao
- Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Yan Huang
- Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Ning-Ning Zhou
- Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Hong-Yun Zhao
- Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Li Zhang
- Medical Oncology of Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
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Zhang Z, Gu XL, Chen ML, Liu MH, Zhao WW, Cheng WW. Use of Palliative Chemo- and Radiotherapy at the End of Life in Patients With Cancer: A Retrospective Cohort Study. Am J Hosp Palliat Care 2016; 34:801-805. [PMID: 27281134 DOI: 10.1177/1049909116653733] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Administration of chemotherapy and radiotherapy near the end of life is a frequently discussed issue nowadays. We have evaluated the factors associated with the use of chemotherapy and radiotherapy at the end of life among terminally ill patients in China. METHODS This study included the data from patients who had died from advanced cancer who underwent palliative chemotherapy and radiotherapy between January 2007 and December 2013 at the Department of Palliative Care of Fudan University, Shanghai Cancer Center. Data were collected from hospital medical records. Univariate and multivariate analyses were conducted to identify the factors independently associated with the use of chemo- and radiotherapy. RESULTS Among the 410 patients included (median age, 68 years; range, 18-93; 53% males), 47 (11.5%) underwent palliative chemotherapy and 28 (6.8%) underwent radiotherapy in the last 30 days. Age <65 years (odds ratio [OR]: 1.33, 95% confidence interval [CI]: 1.06-2.88), performance status <3 (OR: 3.95; 95% CI: 1.56-5.07), and cardiopulmonary resuscitation (OR: 4.09, 95% CI: 2.66-5.34) were independently associated with the use of chemotherapy. Performance status <3 (OR: 4.06, 95% CI: 2.17-5.83) and cardiopulmonary resuscitation (OR: 5.28, 95% CI: 3.77-7.21) were independently associated with the use of radiotherapy. CONCLUSION The findings indicate that younger patients with a lower performance status who do not have complications are more likely to opt for chemo- or radiotherapy. Further, the use of palliative chemo- and radiotherapy should be considered carefully in terminally ill patients with cancer, as they seem to indicate a higher risk of cardiovascular complications requiring resuscitation.
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Affiliation(s)
- Zhe Zhang
- 1 Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiao-Li Gu
- 1 Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Meng-Lei Chen
- 1 Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ming-Hui Liu
- 1 Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei-Wei Zhao
- 1 Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wen-Wu Cheng
- 1 Department of Integrated Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.,2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Sharma N, Sharma AM, Wojtowycz MA, Wang D, Gajra A. Utilization of palliative care and acute care services in older adults with advanced cancer. J Geriatr Oncol 2016; 7:39-46. [PMID: 26769146 DOI: 10.1016/j.jgo.2015.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 10/31/2015] [Accepted: 12/07/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVES There is a gap in knowledge regarding the rates of utilization of palliative care services (PCS) and acute care services (ACS) among older patients with advanced cancer close to end of life. We analyzed the utilization of these services among older adults (65 years and older) and compared them to those in younger adults (40-64 years) with advanced cancer. MATERIALS AND METHODS A retrospective chart review of 567 veterans who died with advanced cancer between 2002 and 2009 and utilized PCS and ACS prior to death was conducted after IRB approval. To assess PCS utilization, we studied the mean duration between day of hospice referral and time of death (DOR) and the mean length of stay with hospice (LoS). The frequency of emergency room visits (ERVLM), hospital admissions (HALM), and ICU admissions (ICULM) in the last month of life was used as a measure for ACS. The differences among older and younger patients were compared using two sample t-tests. RESULTS Older adults had earlier referral to PCS [mean DOR: 47.3 versus 34.5 days, p=0.015], longer stay with hospice [mean LoS: 32.5 versus 20.2 days, p=0.007], fewer hospital [HALM: 0.7 versus 0.9, p=0.043], and ICU admissions [ICULM: 0.1 versus 0.2, p=0.030] per patient. The proportion of patients utilizing ER visits [53.5 % versus 59.5%, p=0.173] and hospital admissions [58.6% versus 65.1%, p=0.13] in the last month of life was similar in both age groups with fewer older adults utilizing ICU care [13.2% versus 19.5%, p=0.047]. CONCLUSION Older patients with cancer are likely to be referred to PCS earlier than younger patients and spend a longer duration with PCS prior to death. However, there continues to be significant utilization of ACS in all patients with advanced cancer. Better understanding of the goals of care in older adults with cancer and education of oncology providers regarding the need to utilize and integrate palliative care services earlier in the course of disease is imperative.
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Affiliation(s)
- Namita Sharma
- SUNY Upstate University, Department of Medicine, Syracuse, NY 13210, USA; VA Medical Center, Syracuse, NY, USA
| | - Amit M Sharma
- SUNY Upstate University, Department of Medicine, Syracuse, NY 13210, USA; VA Medical Center, Syracuse, NY, USA
| | - Martha A Wojtowycz
- SUNY Upstate University, Department of Public Health and Preventive Medicine, Syracuse, NY 13210, USA
| | - Dongliang Wang
- SUNY Upstate University, Department of Public Health and Preventive Medicine, Syracuse, NY 13210, USA
| | - Ajeet Gajra
- SUNY Upstate University, Department of Medicine, Syracuse, NY 13210, USA; VA Medical Center, Syracuse, NY, USA.
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Anshushaug M, Gynnild MA, Kaasa S, Kvikstad A, Grønberg BH. Characterization of patients receiving palliative chemo- and radiotherapy during end of life at a regional cancer center in Norway. Acta Oncol 2015; 54:395-402. [PMID: 25162953 DOI: 10.3109/0284186x.2014.948061] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Many cancer patients receive chemotherapy and radiotherapy their last 30 days [end of life (EOL)]. The benefit is questionable and side effects are common. The aim of this study was to investigate what characterized the patients who received chemo- and radiotherapy during EOL, knowledge that might be used to improve practice. METHODS Patients dead from cancer in 2005 and 2009 were analyzed. Data were collected from hospital medical records. When performance status (PS) was not stated, PS was estimated from other information in the records. A Glasgow Prognostic Score (GPS) of 0, 1 or 2 was assessed from blood values (CRP and albumin). A higher score is associated with a shorter prognosis. RESULTS In total 616 patients died in 2005; 599 in 2009. Among the 723 analyzed, median age was 71; 42% had metastases at diagnosis (synchronous metastases); 53% had PS 2 and 16% PS 3-4 at the start of last cancer therapy. GPS at the start of last cancer therapy was assessable in 70%; of these, 26% had GPS 1 and 35% GPS 2. Overall, 10% received chemotherapy and 8% radiotherapy during EOL. The proportions varied significantly between the different types of cancer. Multivariate analyses revealed that those at age<70 years, GPS 2, no contact with our Palliative Care Unit and synchronous metastases received most chemotherapy the last 30 days. PS 3-4, GPS 2 and synchronous metastases were strongest associated with radiotherapy the last 30 days. CONCLUSION Ten percent received chemotherapy and 8% radiotherapy the last 30 days of life. GPS 2 and synchronous metastases were most significantly associated with cancer therapy the last 30 days of life, indicating that in general, patients with the shortest survival time after diagnosis of cancer received more chemo- and radiotherapy during EOL than other patients.
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Affiliation(s)
- Malin Anshushaug
- European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology , Trondheim , Norway
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The association between individual income and aggressive end-of-life treatment in older cancer decedents in Taiwan. PLoS One 2015; 10:e0116913. [PMID: 25585131 PMCID: PMC4293148 DOI: 10.1371/journal.pone.0116913] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 12/16/2014] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To examine the association of individual income and end of life (EOL) care in older cancer decedents in Taiwan. DESIGN Retrospective cohort study. SETTING National Health Insurance Research Database (NHIRD) in Taiwan. PARTICIPANTS 28,978 decedents >65 years were diagnosed with cancer and died during 2009-2011 in Taiwan. Of these decedents, 10941, 16535, and 1502 were categorized by individual income as having low, moderate, and high SES, respectively. MAIN OUTCOME MEASURES Indicators of aggressiveness of EOL care: chemotherapy use before EOL, more than one emergency department (ER) visit, more than one hospital admission, hospital length of stay >14 days, intensive care unit (ICU) admission, and dying in a hospital. RESULTS Low individual income was associated with more aggressive EOL treatment (estimate -0.30 for moderate income, -0.27 for high income, both p<0.01). The major source of aggressiveness was the tendency for older decedents with low income to die in the acute care hospital. The indicators had an increasing trend from 2009 to 2011, except for hospital stay >14 days. CONCLUSIONS Low individual income is associated with more aggressive EOL treatment in older cancer decedents. Public health providers should make available appropriate education and hospice resources to these decedents and their families, to reduce the amount of aggressive terminal care such decedents receive.
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10
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Chang TS, Su YC, Lee CC. Determinants for aggressive end-of-life care for oral cancer patients: a population-based study in an Asian country. Medicine (Baltimore) 2015; 94:e460. [PMID: 25634186 PMCID: PMC4602967 DOI: 10.1097/md.0000000000000460] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Few studies have addressed the association between oral cancer and end-of-life (EOL) aggressive care using population data. We investigated the relationship between patient demographics, primary physician's specialty, and hospital characteristics of patients who died from oral cancer in Taiwan from 2009 to 2011 and the aggressiveness of their EOL care. This nationwide population-based, retrospective cohort study identified 5386 patients who died from oral cancer identified from Taiwan's National Register of Deaths Database and collected their claims data from Taiwan's National Health Insurance Research Database. Accepted indicators of aggressiveness of EOL care were examined using a composite measure adapted from Earle et al. Scores ranged from 0 to 6; the higher the score, the more aggressive the EOL care. The impact of each variable on the aggressiveness of EOL care was examined by multivariate analysis using a random-intercept model. The mean composite score for aggressiveness of EOL care was 2.68 ± 1.37. Oral cancer patients who were younger, had a higher level of comorbidity or metastasis, belonged to a lower-level individual socioeconomic status, were cared for by nononcologists, had longer postdiagnosis survival times, or resided in urban areas were more likely to receive aggressive care at EOL. Compared with previous studies, oral cancer patients near death in this nationwide study had a far higher utilization rate (>50%) of chemotherapy, emergency room services, and intensive care unit services. Our findings indicate that oral cancer patients receive extensive aggressive medical care at EOL. Future research may be needed to examine the effect of the means (indicators) of aggressive treatment on survival, quality of life, and medical costs, especially since current research suggests such care may adversely affect quality of life and important preparation of death in these patients.
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Affiliation(s)
- Ting-Shou Chang
- From the Department of Otolaryngology (T-SC), Kaohsiung Veterans General Hospital, Kaohsiung; Institute of Public Health (T-SC), College of Medicine, National Cheng Kung University, Tainan; National Defense Medical Center (T-SC), Taipei; Department of Otolaryngology (C-CL); Department of Internal Medicine (Y-CS); Cancer Center (C-CL), Buddhist Dalin Tzu Chi General Hospital, Chiayi; and School of Medicine (Y-CS, C-CL), Tzu Chi University, Hualian, Taiwan
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Kao CY, Hung YS, Wang HM, Chen JS, Chin TL, Lu CY, Chi CC, Yeh YC, Yang JM, Yen JH, Chou WC. Combination of initial palliative prognostic index and score change provides a better prognostic value for terminally ill cancer patients: a six-year observational cohort study. J Pain Symptom Manage 2014; 48:804-14. [PMID: 24709367 DOI: 10.1016/j.jpainsymman.2013.12.246] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/18/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
Abstract
CONTEXT The Palliative Prognostic Index (PPI) is among the most popular scores used to predict life expectancy in terminally ill patients worldwide. PPI assessed on the first day of palliative care might be inappropriate because the contribution from subsequent changes in a patient's condition are not taken into account. OBJECTIVES The aim of this study is to determine the utility of sequential PPI assessments as a better prognostic tool for patients with terminal cancer. METHODS In total, 2392 terminally ill cancer patients with initial and one-week PPI assessments under the palliative care consultation service between January 2006 and December 2011 at a single medical center in Taiwan were selected. Patients were categorized into initial PPI, Week 1 PPI, score change (initial PPI - Week 1 PPI; Δscore), and combined initial PPI and Δscore subgroups for survival analysis. RESULTS Overall median survival was 32 days (range eight to 180 days), and 2183 patients (91.3%) died within 180 days of palliative care consultation service care. A significant difference in survival was observed among patient subgroups (P < 0.001). Subgroup survival analysis showed significant difference in patients with Δscores >0, 0, and <0 in each prognostic group categorized by initial PPI. The c-statistic for predicting life expectancy <30 days was significantly higher with the combined initial PPI and Δscore (c-statistic, 0.71; 95% CI, 0.694-0.731) than with the initial PPI (c-statistic, 0.63; 95% CI, 0.61-0.65), Week 1 PPI (c-statistic, 0.67; 95% CI, 0.652-0.690), or Δscore (c-statistic, 0.64; 95% CI, 0.62-0.66). CONCLUSION Combination of initial PPI and score change is more useful than initial PPI for identifying patients with poor outcomes in good prognostic groups and patients with better outcomes in poor prognostic groups.
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Affiliation(s)
- Chen-Yi Kao
- Division of Hematology-Oncology, Department of Internal Medicine, Taoyuan, Taiwan
| | - Yu-Shin Hung
- Division of Hematology-Oncology, Department of Internal Medicine, Taoyuan, Taiwan
| | - Hung-Ming Wang
- Division of Hematology-Oncology, Department of Internal Medicine, Taoyuan, Taiwan
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Department of Internal Medicine, Taoyuan, Taiwan
| | - Tsu-Ling Chin
- Department of Nursing, Chang Gung Memorial Hospital at Linkou and School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Yi Lu
- Department of Nursing, Chang Gung Memorial Hospital at Linkou and School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chuan-Chuan Chi
- Department of Nursing, Chang Gung Memorial Hospital at Linkou and School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Chi Yeh
- Department of Nursing, Chang Gung Memorial Hospital at Linkou and School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jin-Mei Yang
- Department of Nursing, Chang Gung Memorial Hospital at Linkou and School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jung-Hsuan Yen
- Department of Nursing, Chang Gung Memorial Hospital at Linkou and School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Department of Internal Medicine, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China.
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13
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Chou WC, Hung YS, Kao CY, Su PJ, Hsieh CH, Chen JS, Liau CT, Lin YC, Liaw CC, Wang HM. Impact of palliative care consultative service on disease awareness for patients with terminal cancer. Support Care Cancer 2013; 21:1973-81. [DOI: 10.1007/s00520-013-1733-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
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14
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Affiliation(s)
- Jenni Burt
- Department of Public Health and Primary Care, Institute of Public Health, Cambridge, UK
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