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Borregaard Myrhøj C, Clemmensen SN, Jarden M, Johansen C, von Heymann A. Compassionate Communication and Advance Care Planning to improve End-of-life Care in Treatment of Haematological Disease 'ACT': Study Protocol for a Cluster-randomized trial. BMJ Open 2024; 14:e085163. [PMID: 38772898 PMCID: PMC11110583 DOI: 10.1136/bmjopen-2024-085163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/08/2024] [Indexed: 05/23/2024] Open
Abstract
INTRODUCTION To support the implementation of advance care planning and serious illness conversations in haematology, a previously developed conversation intervention titled 'Advance Consultations Concerning your Life and Treatment' (ACT) was found feasible. This study aims to investigate the effect of ACT on the quality of end-of-life care in patients with haematological malignancy and their informal caregivers. METHODS AND ANALYSIS The study is a nationwide 2-arm cluster randomised trial randomising 40 physician-nurse clusters across seven haematological departments in Denmark to provide standard care or ACT intervention. A total of 400 patients with haematological malignancies and their informal caregivers will be included. The ACT intervention includes an ACT conversation that centres on discussing the patient's prognosis, worries, hopes and preferences for future treatment. The intervention is supported by clinician training and supervision, preparatory materials for patients and informal caregivers, and system changes including dedicated ACT-conversation timeslots and templates for documentation in medical records.This study includes two primary outcomes: (1) the proportion of patients receiving chemotherapy within the last 30 days of death and (2) patients' and informal caregivers' symptoms of anxiety (General Anxiety Disorder-7) at 3 6, 9, 12 and 18 months follow-up. Mixed effects models accounting for clusters will be used. ETHICS AND DISSEMINATION The Declaration of Helsinki and the European GDPR regulations as practised in Denmark are followed through all aspects of the study. Findings will be made available to the participants, patient organisations, funding bodies, healthcare professionals and researchers at national and international conferences and through publication in peer-reviewed international journals. REGISTRATION DETAILS The study is registered at ClinicalTrials.gov (NCT05444348). The Regional Ethics Committee of the Capital Region of Denmark (record no: 21067634) has decided that approval is not necessary as per Danish legislation. Study approval has been obtained from The Capital Region of Denmark Data Protection Agency (record no: P-2022-93). TRIAL REGISTRATION NUMBER NCT05444348.
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Affiliation(s)
- Cæcilie Borregaard Myrhøj
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
- CASTLE - Cancer Survivorship and Treatment Late Effects Research Unit, Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Mary Jarden
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Johansen
- CASTLE - Cancer Survivorship and Treatment Late Effects Research Unit, Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annika von Heymann
- CASTLE - Cancer Survivorship and Treatment Late Effects Research Unit, Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
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Huang HW, Liu CY, Tung TH, Liu LN. Effects of hospice-shared care on terminal cancer patients in Taiwan: A hospital-based observational study. Eur J Oncol Nurs 2024; 69:102525. [PMID: 38340644 DOI: 10.1016/j.ejon.2024.102525] [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: 04/18/2023] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To assess how hospice-shared care (HSC) affected the likelihood of aggressive medical treatments and the life quality among terminal cancer patients. METHODS In the first part, a cohort of 160 late-stage cancer patients who died in non-hospice wards were identified to review their charts in their last 22 days before death. In the second part, a total of 19 late-stage cancer patients with clear consciousness admitted to non-hospice wards were identified to investigate their quality of life for the final 2 weeks before death. RESULTS The utilization rate of HSC was 55.6%. Among these, the rate for late referral to HSC (≤7 days before death) was 43.8% and early referral (>3 months before death) was 5.6%. Compared to the non-HSC group, in the last few weeks of life, the HSC group underwent lower incidence of chemotherapy use (10.1% vs. 39.4%, p < .001), signed do-not-resuscitate orders (0% vs. 21.1%, p < .001), emergency room visits (13.5% vs. 40.8%, p < .001), intensive care unit admission or ventilator use (2.2% vs. 11.3%, p = .019), and endotracheal intubation (2.2% vs. 9.9%, p = .038). However, the quality of life did not appear to have obvious differences between the two groups (p > .05). CONCLUSION In Taiwan, late HSC referral in terminal cancer patients is common. HSC is associated with a reduced likelihood of aggressive medical utilization. However, the effect of HSC in improving patients' quality of life in the last few weeks needs to be further evaluated.
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Affiliation(s)
- Hui-Wen Huang
- Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chun-Yu Liu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan; Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China
| | - Li-Ni Liu
- Department of Nursing, Fu Jen Catholic University, New Taipei City, Taiwan.
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Szigethy E, Dorantes R, Sugrañes M, Madera M, Sola I, Urrútia G, Bonfill X. Frequency of anticancer drug use at the end of life: a scoping review. Clin Transl Oncol 2024; 26:178-189. [PMID: 37286888 PMCID: PMC10247343 DOI: 10.1007/s12094-023-03234-1] [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: 03/26/2023] [Accepted: 05/25/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE Anticancer drug use at the end of life places potential extra burdens on patients and the healthcare system. Previous articles show variability in methods and outcomes; thus, their results are not directly comparable. This scoping review describes the methods and extent of anticancer drug use at end of life. METHODS Systematic searches in Medline and Embase were conducted to identify articles reporting anticancer drug use at the end of life. RESULTS We selected 341 eligible publications, identifying key study features including timing of research, disease status, treatment schedule, treatment type, and treatment characteristics. Among the subset of 69 articles of all cancer types published within the last 5 years, we examined the frequency of anticancer drug use across various end of life periods. CONCLUSION This comprehensive description of publications on anticancer drug use at end of life underscores the importance of methodological factors when designing studies and comparing outcomes.
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Affiliation(s)
- Endre Szigethy
- PhD Programme in Biomedical Research Methodology and Public Health, Universitat Autònoma de Barcelona, Barcelona, Spain.
- Epidy Kft, Debrecen, Hungary.
| | - Rosario Dorantes
- Centre Assistencial Dr. Emili Mira, Parc de Salut Mar, Santa Coloma de Gramenet, Barcelona, Spain
| | - Miguel Sugrañes
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Meisser Madera
- Research Department, Faculty of Dentistry, University of Cartagena, Cartagena, Colombia
| | - Ivan Sola
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gerard Urrútia
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Bonfill
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Universitat Autònoma de Barcelona, Barcelona, Spain
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Raunkiær M, Shabnam J, Marsaa K, Kurita GP, Sjøgren P, Guldin MB. When and how to stop palliative antineoplastic treatment and to organise palliative care for patients with incurable cancer. Int J Palliat Nurs 2023; 29:499-506. [PMID: 37862155 DOI: 10.12968/ijpn.2023.29.10.499] [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] [Indexed: 10/22/2023]
Abstract
BACKGROUND Improving the organisational aspects of the delivery of palliative care in order to support patients throughout their disease trajectory has received limited attention. AIM To investigate the opportunities and barriers related to organising palliation for people with terminal cancer and their families. METHODS An explorative interview study was conducted among 31 nurses and three physicians concerning an intervention facilitating a fast transition from treatment at a cancer centre at a university hospital to palliation at home. A thematic analysis was conducted. FINDINGS This article presents three out of seven themes: 1) improvement in the cessation of antineoplastic treatment in palliation; 2) improvement in organisations delivering palliation; and 3) improvement in multidisciplinary and cross-sectoral collaboration. CONCLUSIONS The results demonstrate the demand for flexible, family-centred and integrated palliation at all levels, from communication and the collaborative relationship between healthcare professionals and families to service sectors.
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Affiliation(s)
- Mette Raunkiær
- Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | - Jahan Shabnam
- Danish Knowledge Centre of Rehabilitation and Palliative Care, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | | | - Geana Paula Kurita
- Section of Palliative Medicine, Department of Oncology, Copenhagen University Hospital, Denmark; Department of Anaesthesiology, Pain and Respiratory Support, Neuroscience Centre-Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Per Sjøgren
- Section of Palliative Medicine, Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Denmark
| | - Mai-Britt Guldin
- Research Unit for General Practice, Aarhus, and Institute for Public Health, Aarhus University
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Vestergaard AHS, Ehlers LH, Neergaard MA, Christiansen CF, Valentin JB, Johnsen SP. Healthcare Costs at the End of Life for Patients with Non-cancer Diseases and Cancer in Denmark. PHARMACOECONOMICS - OPEN 2023; 7:751-764. [PMID: 37552432 PMCID: PMC10471564 DOI: 10.1007/s41669-023-00430-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES To examine costs of care from a healthcare sector perspective within 1 year before death in patients with non-cancer diseases and patients with cancer. METHODS This nationwide registry-based study identified all Danish citizens dying from major non-cancer diseases or cancer in 2010-2016. Applying the cost-of-illness method, we included costs of somatic hospitals, including hospital-based specialist palliative care, primary care, prescription medicine and hospice expressed in 2022 euros. Costs of patients with non-cancer diseases and cancer were compared using regression analyses adjusting for sex, age, comorbidity, residential region, marital/cohabitation status and income level. RESULTS Within 1 year before death, mean total healthcare costs were €27,185 [95% confidence interval (CI) €26,970-27,401] per patient with non-cancer disease (n = 109,723) and €51,348 (95% CI €51,098-51,597) per patient with cancer (n = 108,889). The adjusted relative total healthcare costs, i.e. the ratio of the mean costs, of patients with non-cancer diseases was 0.64 (95% CI 0.63-0.66) at 12 months before death and 0.91 (95% CI 0.90-0.92) within 30 days before death compared with patients with cancer. Mean costs of hospital-based specialist palliative care and hospice in the year leading up to death were €17 (95% CI €13-20) and €90 (95% CI €77-102) per patient with non-cancer disease but €1552 (95% CI €1506-1598) and €3411 (95% CI €3342-3480) per patient with cancer. CONCLUSIONS Within 1 year before death, total healthcare costs, mainly driven by hospital costs, were substantially lower for patients with non-cancer diseases compared with patients with cancer. Moreover, the costs of hospital-based specialist palliative care and hospice were minimal for patients with non-cancer diseases.
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Affiliation(s)
- Anne Høy Seemann Vestergaard
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark.
| | - Lars Holger Ehlers
- Danish Center for Healthcare Improvements, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg Ø, Denmark
- Nordic Institute of Health Economics, Aarhus, Denmark
| | - Mette Asbjoern Neergaard
- Palliative Care Unit, Department of Oncology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg Ø, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Healthcare Improvements, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg Ø, Denmark
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg Ø, Denmark
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Vestergaard AHS, Neergaard MA, Fokdal LU, Christiansen CF, Valentin JB, Johnsen SP. Utilisation of hospital-based specialist palliative care in patients with gynaecological cancer: Temporal trends, predictors and association with high-intensity end-of-life care. Gynecol Oncol 2023; 172:1-8. [PMID: 36905767 DOI: 10.1016/j.ygyno.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To examine hospital-based specialist palliative care (SPC) utilisation among patients with gynaecological cancer, including temporal trends, predictors and associations with high-intensity end-of-life care. METHODS We conducted a nationwide registry-based study for all patients dying from gynaecological cancer in Denmark during 2010-2016. We estimated the proportions of patients receiving SPC by year of death and used regression analyses to examine predictors of SPC utilisation. Use of high-intensity end-of-life care according to SPC utilisation was compared by regression analyses adjusting for type of gynaecological cancer, year of death, age, comorbidities, residential region, marital/cohabitation status, income level and migrant status. RESULTS Among 4502 patients dying from gynaecological cancer, the proportion of patients receiving SPC increased from 24.2% in 2010 to 50.7% in 2016. Young age, three or more comorbidities, residence outside the Capital Region and being immigrant/descendant were associated with increased SPC utilisation, whereas income, cancer type and stage were not. SPC was associated with lower high-intensity end-of-life care utilisation. Particularly, when compared with patients not receiving SPC, patients who accessed SPC >30 days before death had 88% lower risk of intensive care unit admissions within 30 days before death (adjusted relative risk: 0.12 (95% CI: 0.06; 0.24)) and 96% lower risk of surgery within 14 days before death (adjusted relative risk: 0.04 (95% CI: 0.01; 0.31)). CONCLUSIONS Among patients dying from gynaecological cancer, SPC utilisation increased over time and age, comorbidities, residential region and migrant status were associated with access to SPC. Furthermore, SPC was associated with lower use of high-intensity end-of-life care.
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Affiliation(s)
- Anne Høy Seemann Vestergaard
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Alle 43-45, 8200 Aarhus N, Denmark.
| | - Mette Asbjoern Neergaard
- Palliative Care Unit, Oncology Department, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Lars Ulrik Fokdal
- Department of Oncology, Vejle Hospital, Kabbeltoft 25, 7100 Vejle, Denmark; Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Christian Fynbo Christiansen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Alle 43-45, 8200 Aarhus N, Denmark
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Frederik Bajers Vej 5, 9220 Aalborg Ø, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Frederik Bajers Vej 5, 9220 Aalborg Ø, Denmark
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Davidoff AJ, Canavan ME, Prsic E, Saphire M, Wang SY, Presley CJ. End-of-life care trajectories among older adults with lung cancer. J Geriatr Oncol 2023; 14:101381. [PMID: 36202695 PMCID: PMC9974538 DOI: 10.1016/j.jgo.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/22/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Medicare decedents with cancer often receive intensive care during the last month of life; however, little information exists on longer end-of-life care trajectories. MATERIALS AND METHODS Using SEER-Medicare data, we selected older adults diagnosed with lung cancer between 2008 and 2013 who survived at least six months and died between 2008 and 2014. Each month we assessed claims to assign care categories ordered by intensity as follows: full-month inpatient/skilled nursing facility > cancer-directed therapy (CDT) only > concurrent CDT and symptom management and supportive care services (SMSCS) > SMSCS only > full-month hospice. We assigned each decedent to one of six trajectories: stable hospice, stable SMSCS, stable CDT with or without concurrent SMSCS, decreasing intensity, increasing intensity, and mixed. Multinomial logistic regression estimated associations between socio-demographics, calendar year, and area hospice use rates with end-of-life trajectory. RESULTS The sample (N = 24,342) was predominantly aged ≥75 years (59.4%) and non-Hispanic White (80.5%); 19.1% lived in healthcare referral regions where ≤50% of cancer decedents received hospice care. Overall, 6.5% were continuously hospice enrolled, 25.6% received SMSCS only, and 29.4% experienced decreasing intensity; 3.9% received CDT or concurrent care, while 8.7% experienced an increase in intensity. Higher healthcare referral region hospice rates were associated with decreasing end-of-life intensity; Black, non-Hispanic decedents had a higher risk of increasing intensity and mixed patterns. DISCUSSION Among older decedents with lung cancer, 62% had six-month end-of-life trajectories indicating low or decreasing intensity, but few received persistent CDT. Demographic characteristics, including race/ethnicity, and contextual measures, including area hospice use patterns, were associated with end-of-life trajectory.
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Affiliation(s)
- Amy J Davidoff
- Yale School of Public Health, New Haven, CT, United States of America; Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, New Haven, CT, United States of America; Yale Cancer Center, New Haven, CT, United States of America.
| | - Maureen E Canavan
- Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, New Haven, CT, United States of America
| | - Elizabeth Prsic
- Yale-Smilow Cancer Hospital, New Haven, CT, United States of America
| | - Maureen Saphire
- The Ohio State University Comprehensive Cancer Center, Department of Pharmacy, Columbus, OH, United States of America
| | - Shi-Yi Wang
- Yale School of Public Health, New Haven, CT, United States of America; Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, New Haven, CT, United States of America; Yale Cancer Center, New Haven, CT, United States of America
| | - Carolyn J Presley
- Cancer Outcomes, Public Policy and Effectiveness Research Center (COPPER), Yale School of Medicine, New Haven, CT, United States of America; The Ohio State University Comprehensive Cancer Center, Department of Internal Medicine, Division of Medical Oncology, Columbus, OH, United States of America
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Jøhnk C, Laigaard HH, Pedersen AK, Bauer EH, Brandt F, Bollig G, Wolff DL. Time to End-of-Life of Patients Starting Specialised Palliative Care in Denmark: A Descriptive Register-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13017. [PMID: 36293593 PMCID: PMC9602996 DOI: 10.3390/ijerph192013017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
Increasing numbers of patients are being referred to specialised palliative care (SPC) which, in order to be beneficial, is recommended to last more than three months. This cohort study aimed to describe time to end-of-life after initiating SPC treatment and to explore potential regional variations. We used national register data from all Danish hospital SPC teams. We included patients who started SPC treatment from 2015-2018 to explore if time to end-of-life was longer than three months. Descriptive statistics were used to summarise the data and a generalised linear model was used to assess variations among the five Danish regions. A total of 27,724 patients were included, of whom 36.7% (95% CI 36.2-37.1%) had over three months to end-of-life. In the Capital Region of Denmark, 40.1% (95% CI 39.0-41.3%) had over three months to end-of-life versus 32.5% (95% CI 30.9-34.0%) in North Denmark Region. We conclude that most patients live for a shorter period of time than the recommended three months after initiating SPC treatment. This is neither optimal for patient care, nor the healthcare system. A geographical variation between regions was shown indicating different practices, patient groups or resources. These results warrant further investigation to promote optimal SPC treatment.
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Affiliation(s)
- Camilla Jøhnk
- Department of Internal Medicine, Hospital Sønderjylland, University Hospital of Southern Denmark, Sydvang 1, 6400 Sønderborg, Denmark
| | - Helene Holm Laigaard
- Department of Internal Medicine, Hospital Sønderjylland, University Hospital of Southern Denmark, Sydvang 1, 6400 Sønderborg, Denmark
| | - Andreas Kristian Pedersen
- Department of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense, Denmark
- Department of Clinical Research, Hospital Sønderjylland, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200 Aabenraa, Denmark
| | - Eithne Hayes Bauer
- Department of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense, Denmark
- Internal Medicine Research Unit, Hospital Sønderjylland, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200 Aabenraa, Denmark
| | - Frans Brandt
- Department of Internal Medicine, Hospital Sønderjylland, University Hospital of Southern Denmark, Sydvang 1, 6400 Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense, Denmark
- Internal Medicine Research Unit, Hospital Sønderjylland, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200 Aabenraa, Denmark
| | - Georg Bollig
- Department of Internal Medicine, Hospital Sønderjylland, University Hospital of Southern Denmark, Sydvang 1, 6400 Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense, Denmark
- Internal Medicine Research Unit, Hospital Sønderjylland, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200 Aabenraa, Denmark
- Department of Anesthesiology, Intensive Care, Palliative Medicine and Pain Therapy, HELIOS Klinikum, 24837 Schleswig, Germany
| | - Donna Lykke Wolff
- Department of Regional Health Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense, Denmark
- Internal Medicine Research Unit, Hospital Sønderjylland, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200 Aabenraa, Denmark
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Iglesias-Santamaría A. Evaluating aggressiveness of end-of-life care in patients with advanced cancer: A retrospective single-center analysis. J Oncol Pharm Pract 2022:10781552221117751. [PMID: 35938188 DOI: 10.1177/10781552221117751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Overuse of anti-cancer therapy near end of life is an important quality-of-care issue. An aggressive approach to treatment can have negative effects on the quality of life and cost of hospital-based resources. The objective of this study was to measure indicators of potential aggressiveness of end-of-life care in a cohort of adult patients with advanced solid tumor. The secondary objective was to analyze the association between clinicopathological variables and indicators of aggressiveness. METHODS Retrospective data analysis was performed on adult patients with solid tumors who received palliative chemotherapy for advanced cancer and died in our hospital between 2017 and 2019. Indicators of aggressiveness of end of life care included chemotherapy use in the last days of life, emergency room visits and hospitalizations (including intensive care unit admissions) in this period, and referral to a palliative care unit before death. Univariate and multivariate analyses were conducted to identify the variables that independently predicted the use of palliative chemotherapy near end of life. RESULTS Of the 571 patients included, 128 (22.4%) received chemotherapy within the last 2 weeks of life and 102 (17.8%) start a new chemotherapy regimen 30 days before death. During the last month of life, 168 patients (32.9%) visited emergency room more than once and 117 (20.5%) were hospitalized more than once. A total of 294 patients (51.5%) died in the acute care unit and 285 (49.9%) were referred to the palliative care unit. 24 of them (8.4%) died within 72h after referral. CONCLUSIONS The percentage of patients receiving chemotherapy near the end of life as well as the rate of emergency room visits and hospitalizations during this period are much higher than the value of the quality standard established in the literature. According to these indicators, cancer patient care at end of life can be considered overly aggressive. Optimization of palliative care at end of life is necessary.
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Formoso G, Marino M, Guberti M, Grilli RG. End-of-life care in cancer patients: how much drug therapy and how much palliative care? Record linkage study in Northern Italy. BMJ Open 2022; 12:e057437. [PMID: 35523497 PMCID: PMC9083387 DOI: 10.1136/bmjopen-2021-057437] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Investigating end-of-life use of anticancer drugs and of palliative care services. DESIGN Population based cohort linked to mortality registry and administrative databases. SETTING Emilia-Romagna Region (Northern Italy). PARTICIPANTS 55 625 residents who died of cancer between 2017 and 2020. PRIMARY AND SECONDARY OUTCOME MEASURES Multivariate analyses were carried out to assess the relationship between cancer drug therapy and palliative care services, and their association with factors related to tumour severity. RESULTS In the last month of life, 15.3% of study population received anticancer drugs (from 12.5% to 16.9% across the eight Local Health Authorities-LHA) and 40.2% received palliative care services (from 36.2% to 43.7%). Drug therapy was inversely associated with receiving palliative care services within the last 30 days (OR 0.92, 95% CI 0.87 to 0.97), surgery within the last 6 months (OR 0.59, 95% CI 0.52 to 0.67), aggressive tumours (OR 0.88, 95% CI 0.84 to 0.93) and increasing age (OR 0.95, 95% CI 0.95 to 0.95). Drug therapy was more likely among those with haematologic tumours (OR 2.15, 95% CI 2.00 to 2.30) and in case of hospital admissions within the last 6 months (OR 1.63, 95% CI 1.55 to 1.72). Palliative care was less likely among those with haematologic compared with other tumours (OR 0.52, 95% CI 0.49 to 0.56), in case of surgery (OR 0.44, 95% CI 0.39 to 0.49) or hospital admissions (OR 0.70, 95% CI 0.67 to 0.72) within the last 6 months, if receiving anticancer drugs during the last 30 days (OR 0.90, 95% CI 0.85 to 0.94) and for each year of increasing age (OR 0.99, 95% CI 0.99 to 0.99). Palliative care was more likely in the presence of aggressive tumours (OR 1.12, 95% CI 1.08 to 1.16). CONCLUSION Use of anticancer drugs and palliative care in the last month of life were inversely associated, showing variability across different LHAs. While administrative data have limits, our findings are in line with conclusions of other studies.
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Affiliation(s)
- Giulio Formoso
- Clinical Governance Unit, Reggio Emilia Local Agency-IRCCS Advanced Technologies and Care Models in Oncology, Reggio Emilia, Emilia-Romagna, Italy
| | - Massimiliano Marino
- Clinical Governance Unit, Reggio Emilia Local Agency-IRCCS Advanced Technologies and Care Models in Oncology, Reggio Emilia, Emilia-Romagna, Italy
| | - Monica Guberti
- Department of Health Professions, Reggio Emilia Local Agency-IRCCS Advanced Technologies and Care Models in Oncology, Reggio Emilia, Emilia-Romagna, Italy
| | - Roberto Giuseppe Grilli
- Clinical Governance Unit, Reggio Emilia Local Agency-IRCCS Advanced Technologies and Care Models in Oncology, Reggio Emilia, Emilia-Romagna, Italy
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Auclair J, Sanchez S, Chrusciel J, Hannetel L, Frasca M, Economos G, Habert-Dantigny R, Bruera E, Burucoa B, Ecarnot F, Colombet I, Barbaret C. Duration of palliative care involvement and immunotherapy treatment near the end of life among patients with cancer who died in-hospital. Support Care Cancer 2022; 30:4997-5006. [PMID: 35192058 DOI: 10.1007/s00520-022-06901-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) have revolutionised cancer treatment, but their use near the end of life in patients with advanced cancer is poorly documented. This study investigated the association between administration of ICI therapy in the last month of life and the duration of involvement of the palliative care (PC) team, among patients with advanced cancer who died in-hospital. METHODS In a retrospective, multicentre study, we included all patients who died in 2018 of melanoma, head and neck carcinoma, non-small cell lung cancer or urothelial or renal cancer, in 2 teaching hospitals and one community hospital in France. The primary outcome was the association between ICI therapy in the last month of life and duration of involvement of the PC team in patient management. RESULTS Among 350 patients included, 133 (38%) received anti-cancer treatment in the last month of life, including 71/133 (53%) who received ICIs. A total of 207 patients (59%) received palliative care, only 127 (36%) 30 days before death. There was a significant association between ongoing ICI therapy in the last month of life and shorter duration of PC management (p = 0.04). Receiving ICI therapy in the last month of life was associated with an increased risk of late PC initiation by multivariate regression analysis (hazard ratio 1.668; 95% CI 1.022-2.722). CONCLUSION ICI therapy is frequently used close to the end of life in patients with advanced cancer. Innovative new anti-cancer treatments should not delay PC referral. Improved collaboration between PC and oncological teams is needed to address this issue.
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Affiliation(s)
- Juline Auclair
- Department of Palliative Care, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - Stéphane Sanchez
- Department of Public Health and Performance, Hôpitaux Champagne Sud, Troyes, France
| | - Jan Chrusciel
- Department of Public Health and Performance, Hôpitaux Champagne Sud, Troyes, France
| | - Louise Hannetel
- Department of Palliative Care, Hôpitaux Champagne Sud, Troyes, France
| | - Matthieu Frasca
- Department of Palliative Care, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - Guillaume Economos
- Department of Supportive and Palliative Care, Centre Hospitalo-Universitaire de Lyon-Sud, Lyon, France
| | - Raphaelle Habert-Dantigny
- Department of Supportive and Palliative Care, Centre Hospitalo-Universitaire de Grenoble, Avenue du Maquis du Grésivaudan, La Tronche, 38700, Grenoble, France
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Benoit Burucoa
- Department of Palliative Care, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besançon, University of Franche-Comté, EA392025000, Besançon, France
| | | | - Cécile Barbaret
- Department of Supportive and Palliative Care, Centre Hospitalo-Universitaire de Grenoble, Avenue du Maquis du Grésivaudan, La Tronche, 38700, Grenoble, France.
- Laboratoire ThEMAS (Techniques pour l'évaluation et la Modélisation des Actions de Santé (TIMC-IMAG : Technique de l'Ingénierie Médicale et de la Compléxité-Informatique, Mathématiques et Applications, Grenoble), Grenoble, France.
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12
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Adsersen M, Chen IM, Rasmussen LS, Johansen JS, Nissen M, Groenvold M, Marsaa K. Regional and age differences in specialised palliative care for patients with pancreatic cancer. BMC Palliat Care 2021; 20:192. [PMID: 34930211 PMCID: PMC8691016 DOI: 10.1186/s12904-021-00870-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/25/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite national recommendations, disparities in specialised palliative care (SPC) admittance have been reported. The aims of this study were to characterize SPC admittance in patients with pancreatic cancer in relation to region of residence and age. METHOD The data sources were two nationwide databases: Danish Pancreatic Cancer Database and Danish Palliative Care Database. The study population included patients (18+ years old) diagnosed with pancreatic cancer from 2011 to 2018. We investigated admittance to SPC, and time from diagnosis to referral to SPC and first contact with SPC to death by region of residence and age. RESULTS In the study period (N = 5851) admittance to SPC increased from 44 to 63%. The time from diagnosis to referral to SPC increased in the study period and overall, the median time was 67 days: three times higher in Southern (92 days) than in North Denmark Region. The median number of days from diagnosis to referral to SPC was lower in patients ≥70 years (59 days) vs patients < 70 years (78 days), with regional differences between the age groups. Region of residence and age were associated with admittance to SPC; highest for patients in North Denmark Region vs Capital Region (OR = 2.03 (95%CI 1.67-2.48)) and for younger patients (< 60 years vs 80+ years) (OR = 2.54 (95%CI 2.05-3.15)). The median survival from admittance to SPC was 35 days: lowest in Southern (30 days) and highest in North Denmark Region (41 days). The median number of days from admittance to SPC to death was higher in patients < 70 years (40 days) vs ≥ 70 years (31 days), with a difference between age groups in the regions of 1-14 days. CONCLUSIONS From 2011 to 2018 more patients with pancreatic cancer than previously were admitted to SPC, with marked differences between regions of residence and age groups. The persistently short period of time the patients are in SPC raises concern that early integrated palliative care is not fully integrated into the Danish healthcare system for patients with pancreatic cancer, with the risk that the referral comes so late that the patients do not receive the full benefit of the SPC.
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Affiliation(s)
- Mathilde Adsersen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Hospital 20D, Bispebjerg Bakke 23B, 2400, Copenhagen, NV, Denmark.
| | - Inna Markovna Chen
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Louise Skau Rasmussen
- Department of Oncology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Julia Sidenius Johansen
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Nissen
- Department of Medicine, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Mogens Groenvold
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Bispebjerg Hospital 20D, Bispebjerg Bakke 23B, 2400, Copenhagen, NV, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer Marsaa
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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13
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Elliott E, Watson T, Singh D, Wong C, Lo SS. Outcomes of Specialty Palliative Care Interventions for Patients With Hematologic Malignancies: A Systematic Review. J Pain Symptom Manage 2021; 62:863-875. [PMID: 33774128 DOI: 10.1016/j.jpainsymman.2021.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/22/2022]
Abstract
CONTEXT The outcomes of specialty palliative care (PC) interventions for patients with hematologic malignancies (HMs) is under-investigated. OBJECTIVES We performed a systematic review to evaluate the effect of PC interventions on patient- and caregiver- reported outcomes and healthcare utilization among adults with HMs (leukemia, myeloma, and lymphoma). METHODS From database inception through September 10, 2020, we systematically searched PubMed, CINAHL, Embase, Scopus, Web of Science, and Cochrane Reviews using terms representing HMs and PC. Eligible studies investigated adults aged 18 years and older, were published in the English language, and contained original, quantitative, or qualitative data related to patient- and/or caregiver-centered outcomes and healthcare utilization. RESULTS We screened 5345 studies;16 met inclusion criteria and found that specialty PC led to improved symptom management, decreased likelihood of inpatient death, decreased healthcare utilization, decreased cost of healthcare, and improved caregiver-reported outcomes. Patients with HM have a high need for PC which, though increasing over time, is often provided late in the clinical disease course. CONCLUSIONS Specialty PC interventions improve healthcare outcomes for patients with HMs and should be implemented early and often. There remains a need for additional studies investigating PC use exclusively in patients with HMs.
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Affiliation(s)
- Elizabeth Elliott
- Department of Medicine, Division of Hematology and Oncology, Cardinal Bernardin Cancer Center, Loyola University Stritch School of Medicine, Maywood, Illinois, USA.
| | - Tracie Watson
- Department of Medicine, Division of Hematology and Oncology, Cardinal Bernardin Cancer Center, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Daulath Singh
- Department of Medicine, Division of Hematology and Oncology, Cardinal Bernardin Cancer Center, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
| | - Connie Wong
- Lane Medical Library & Knowledge Management Center, Stanford University School of Medicine, Stanford, California, USA
| | - Shelly S Lo
- Department of Medicine, Division of Hematology and Oncology, Cardinal Bernardin Cancer Center, Loyola University Stritch School of Medicine, Maywood, Illinois, USA
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14
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Bugge C, Kaasa S, Sæther EM, Melberg HO, Sonbo Kristiansen I. What are determinants of utilisation of pharmaceutical anticancer treatment during the last year of life in Norway? A retrospective registry study. BMJ Open 2021; 11:e050564. [PMID: 34580099 PMCID: PMC8477316 DOI: 10.1136/bmjopen-2021-050564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The objective of this study was to investigate the use of, and predictors for, pharmaceutical anticancer treatment (PACT) towards the end of a patient's life in a country with a public healthcare system. DESIGN Retrospective registry study. SETTING Secondary care in Norway. PARTICIPANTS All Norwegian patients with cancer (International Classification of Diseases tenth revision (ICD-10) codes C00-99, D00-09, D37-48) in contact with a somatic hospital in Norway between 2009 and 2017 (N=420 655). Analyses were performed on a subsample of decedents with follow-back time of more than 1 year (2013-2017, N=52 496). INTERVENTIONS N/A. PRIMARY AND SECONDARY OUTCOME MEASURES Proportion of patients receiving PACT during the last year and month of life. We calculated CIs with block bootstrapping, while predictors of PACT were estimated with logistic regression. RESULTS 24.0% (95% CI 23.4% to 24.6%) of the patients received PACT during the last year of life and 3.2% (95% CI 3.0% to 3.5%) during their final month. The proportion during the last month was highest for multiple myeloma (12.7%) and breast cancer (6.5%) and lowest for urinary tract (1.1%) and prostate and kidney cancer (1.4%). Patients living in northern (OR 0.80, 95% CI 0.68 to 0.94) and western (OR 0.85, 95% CI 0.75 to 0.96) Norway had lower odds of PACT during the last month, while patients with myeloma (OR 3.0, 95% CI 2.5 to 3.7) and breast (OR 1.4, 95% CI 1.1 to 1.6) had higher odds. Kidney cancer (OR 0.25, 95% CI 0.2. to 0.4), urinary tract (OR 0.38, 95% CI 0.3 to 0.5) and prostate cancer (OR 0.4, 95% CI 0.3 to 0.5) were associated with lower probability of receiving PACT within the last month. CONCLUSIONS The proportion of patients receiving PACT in Norway is lower than in several other industrialised countries. Age, type of cancer and area of living are significant determinants of variation in PACT.
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Affiliation(s)
- Christoffer Bugge
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Oslo Economics AS, Oslo, Norway
| | - Stein Kaasa
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Hans Olav Melberg
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Ivar Sonbo Kristiansen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Oslo Economics AS, Oslo, Norway
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15
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Mattsson TO, Pottegård A, Jørgensen TL, Green A, Bliddal M. End-of-life anticancer treatment - a nationwide registry-based study of trends in the use of chemo-, endocrine, immune-, and targeted therapies. Acta Oncol 2021; 60:961-967. [PMID: 33651643 DOI: 10.1080/0284186x.2021.1890332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Anticancer treatments near the end of a patient's life should generally be avoided, as it leaves the patient with no significant anticancer effect but increases the risk of severe side effects. We described the pattern of all end-of-life anticancer treatment in a population of Danish cancer patients. METHODS Using the Danish national health registries, we identified all patients deceased due to cancer 2010-2015. Anticancer treatment registered in the last 30 days of life was categorized as end-of-life treatment. Predictors of such treatment were investigated using logistic regression models. RESULTS We identified 42,277 patients (median age 70 years) of whom 16% received end-of-life anticancer treatment. This proportion did not change during the study period (p = .09). Chemotherapy alone was the most frequent treatment, accounting for 78% of all end-of-life treatment in 2010, decreasing to 71% in 2015. In contrast, end-of-life use of immunotherapy, targeted therapy and endocrine therapy increased during the study period. Breast cancer as index cancer was associated with the highest frequency of end-of-life treatment (23%), followed by malignant melanoma (21%), and prostate cancer (18%). Factors associated with lower odds for end-of-life treatment were female sex, older age, high burden of comorbidity, and being diagnosed >6 months prior to death. CONCLUSIONS We found a stable overall rate at 16% of patients receiving anticancer treatment within one month prior to death in this nationwide sample of cancer deaths. Further research is needed to assess whether this level of end-of-life treatment is justified or reflects inappropriate use.
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Affiliation(s)
- Thea Otto Mattsson
- Department of Oncology, Odense University Hospital, Odense, Denmark
- AgeCare, Academy of Geriatric Cancer Research, Odense University Hospital, Odense, Denmark
| | - Anton Pottegård
- Department of Public Health, Division of Clinical Pharmacology and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Trine Lembrecht Jørgensen
- Department of Oncology, Odense University Hospital, Odense, Denmark
- AgeCare, Academy of Geriatric Cancer Research, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anders Green
- OPEN – Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, and Odense University Hospital, Odense, Denmark
| | - Mette Bliddal
- OPEN – Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark, and Odense University Hospital, Odense, Denmark
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16
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Pitson G, Matheson L, Garrard B, Eastman P, Rogers M. Population-based analysis of radiotherapy and chemotherapy treatment in the last month of life within regional Australia. Intern Med J 2021; 50:596-602. [PMID: 31161700 DOI: 10.1111/imj.14377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cancer treatment near end of life is not likely to add meaningful benefit and minimising intervention rates has been promoted as an indicator of quality of care. Population-based analysis of treatment allows comparative analysis of treatment rates and provides insight into patterns of care. AIMS To report a population-based analysis of both radiotherapy and active systemic therapy (AST) delivery rates along with patterns of treatment within the last 14 and 30 days of life. METHODS The Evaluation of Cancer Outcomes Registry records clinical information on all newly diagnosed cancer patients for the Barwon South West Region of Victoria, Australia. Diagnosis details, tumour type and stage as well as core treatment details and date of death were extracted for all patients diagnosed from 2009 to 2015 inclusive. RESULTS A total of 12 760 cases cancers were recorded. The median age of all cases was 68.8, and 53% were male. AST was received by 3699 (29%) of patients and radiotherapy by 3811 (30%). Patient deaths within 14 and 30 days of treatment for AST were 4.3 and 8.7%, respectively, and deaths within 14 and 30 days of treatment for radiotherapy 3.8 and 8.0% respectively. Factors associated with death within 30 days of AST and/or radiotherapy were male gender, age greater than 70 years and higher disease stage (all P < 0.01). Treatment rates within 30 days of death were highest for lung cancer (23% of cases) and lowest for breast cancer (2% of cases). CONCLUSIONS This population-based analysis of AST and radiotherapy treatment within the last 30 days of life within a region of Australia has shown overall treatment rates below 10%. Treatment rates appear influenced by both patient and tumour characteristics. Future focus on subgroups with high rates of late intervention may help minimise treatment unlikely to add benefit.
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Affiliation(s)
- Graham Pitson
- Cancer Services, Barwon Health, Geelong, Victoria, Australia.,Barwon South Western Region Integrated Cancer Service, Geelong, Victoria, Australia
| | - Leigh Matheson
- Barwon South Western Region Integrated Cancer Service, Geelong, Victoria, Australia
| | - Brooke Garrard
- Barwon South Western Region Integrated Cancer Service, Geelong, Victoria, Australia
| | - Peter Eastman
- Palliative Care, Barwon Health, Geelong, Victoria, Australia
| | - Margaret Rogers
- Barwon South Western Region Integrated Cancer Service, Geelong, Victoria, Australia.,School of Medicine, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Debourdeau P, Belkacémi M, Economos G, Assénat E, Hilgers W, Coussirou J, Kouidri Uzan S, Vasquez L, Debourdeau A, Daures JP, Salas S. Identification of factors associated with aggressive end-of-life antitumour treatment: retrospective study of 1282 patients with cancer. BMJ Support Palliat Care 2020:bmjspcare-2020-002635. [PMID: 33154087 DOI: 10.1136/bmjspcare-2020-002635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Antitumour treatment in the last 2 weeks of death (ATT-W2) and a new regimen of ATT within 30 days of death (NATT-M1) are considered as aggressive end-of-life (EOL) care. We aimed to assess factors associated with inappropriate use of antitumour treatment (ATT) at EOL. METHODS Data of patients with cancer who died in 2013, 2015, 2017 and 2019 in a single for-profit cancer centre were retrospectively analysed. ATT was divided into chemotherapy (CT), oral targeted therapy (OTT), hormonotherapy and immunotherapy (IMT). RESULTS A total of 1282 patients were included. NATT-M1 was given to 197 (15.37%) patients, and 167 (13.03%) had an ATT-W2. Patients with a performance status of <2 and treated with CT had more both ATT- W2 (OR=2.45, 95% CI 1.65 to 3.65, and OR=10.29, 95% CI 4.70 to 22.6, respectively) and NATT-M1 (OR=2.01, 95% CI 1.40 to 2.90, and OR=8.41, 95% CI 4.46 to 15.86). Predictive factors of a higher rate of ATT-W2 were treatment with OTT (OR=19.08, 95% CI 7.12 to 51.07), follow-up by a medical oncologist (OR=1.49, 95% CI 1.03 to 2.17), miscellaneous cancer (OR=3.50, 95% CI 1.13 to 10.85) and length of hospital stay before death of <13 days (OR=1.92, 95% CI 1.32 to 2.79). Urinary tract and male genital cancers received less ATT-W2 (OR=0.38, 95% CI 0.16 to 0.89, and OR=0.40, 95% CI 0.16 to 0.99) and patients treated by IMT or with age <69 years more NATT-M1 (OR=19.21, 95% CI 7.55 to 48.8, and OR=1.69, 95% CI 1.20 to 2.37). Patients followed up by the palliative care team (PCT) had fewer ATT-W2 and NATT-M1 (OR=0.49, 95% CI 0.35 to 0.71, and OR=0.42, 95% CI 0.30 to 0.58). CONCLUSIONS Most recent ATT and access to a PCT follow-up are the two most important potentially modifiable factors associated with aggressive EOL in patients with cancer. Early integrated palliative oncology care could help to decrease futile ATT at EOL.
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Affiliation(s)
- Philippe Debourdeau
- Supportive care unit, Institut sainte Catherine, Avignon, Provence Alpes Côte d'Azur, France
| | - Mohamed Belkacémi
- EA 2415, LBERC, Laboratoire de Biostatistiques, Epidémiologie et Recherche Clinique, Université Montpellier 1, Montpellier, Languedoc-Roussillon, France
| | - Guillaume Economos
- EA3738, Centre d'Investigation en Cancérologie de Lyon, Universite Claude Bernard Lyon 1, Pierre-Bénite, Auvergne-Rhône-Alpes, France
| | - Eric Assénat
- Medical Oncology, Hospital Saint-Eloi, Montpellier, Languedoc-Roussillon, France
| | - Werner Hilgers
- Medical Oncology, Institut Sainte Catherine, Avignon, Provence-Alpes-Côte d'Azu, France
| | - Julie Coussirou
- Pharmacy, Institut Sainte Catherine, Avignon, Provence Alpes Côte d'Azur, France
| | - Sfaya Kouidri Uzan
- Department of Medical Information, Institut Sainte Catherine, Avignon, Provence-Alpes-Côte d'Azu, France
| | - Léa Vasquez
- Department of Medical Information, Institut Sainte Catherine, Avignon, Provence-Alpes-Côte d'Azu, France
| | - Antoine Debourdeau
- Medical Oncology, Hospital Saint-Eloi, Montpellier, Languedoc-Roussillon, France
| | - Jean Pierre Daures
- EA 2415, LBERC, Laboratoire de Biostatistiques, Epidémiologie et Recherche Clinique, Université Montpellier 1, Montpellier, Languedoc-Roussillon, France
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18
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Akhlaghi E, Lehto RH, Torabikhah M, Sharif Nia H, Taheri A, Zaboli E, Yaghoobzadeh A. Chemotherapy use and quality of life in cancer patients at the end of life: an integrative review. Health Qual Life Outcomes 2020; 18:332. [PMID: 33028381 PMCID: PMC7540433 DOI: 10.1186/s12955-020-01580-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 09/24/2020] [Indexed: 11/28/2022] Open
Abstract
Background When curative treatments are no longer available for cancer patients, the aim of treatment is palliative. The emphasis of palliative care is on optimizing quality of life and provided support for patients nearing end of life. However, chemotherapy is often offered as a palliative therapy for patients with advanced cancer nearing death. The purpose of this review was to evaluate the state of the science relative to use of palliative chemotherapy and maintenance of quality of life in patients with advanced cancer who were at end of life.
Materials and methods Published research from January 2010 to December 2019 was reviewed using PRISMA guidelines using PubMed, Proquest, ISI web of science, Science Direct, and Scopus databases. MeSH keywords including quality of life, health related quality of life, cancer chemotherapy, drug therapy, end of life care, palliative care, palliative therapy, and palliative treatment.
Findings 13 studies were evaluated based on inclusion criteria. Most of these studies identified that reduced quality of life was associated with receipt of palliative chemotherapy in patients with advanced cancer at the end of life. Conclusion Studies have primarily been conducted in European and American countries. Cultural background of patients may impact quality of life at end of life. More research is needed in developing countries including Mideastern and Asian countries.
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Affiliation(s)
- Elham Akhlaghi
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.,College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Rebecca H Lehto
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.,College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Mohsen Torabikhah
- Department of Adult Health Nursing, Nursing and Midwifery Faculty, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Sharif Nia
- Department of Nursing, Mazandaran University of Medical Science, Sari, Iran.
| | - Ahmad Taheri
- Department of Adult Health Nursing, Nursing and Midwifery Faculty, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ehsan Zaboli
- Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, 48166-33131, Sari, Iran
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Benthien K, Diasso P, von Heymann A, Nordly M, Kurita G, Timm H, Johansen C, Kjellberg J, von der Maase H, Sjøgren P. Oncology to specialised palliative home care systematic transition: the Domus randomised trial. BMJ Support Palliat Care 2020; 10:350-357. [PMID: 32680894 DOI: 10.1136/bmjspcare-2020-002325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/30/2020] [Accepted: 06/10/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess the effect of a systematic, fast-track transition from oncological treatment to specialised palliative care at home on symptom burden, to explore intervention mechanisms through patient and intervention provider characteristics and to assess long-term survival and place of death. MEASURES The effect of a systematic, fast-track transition from oncological treatment to specialised palliative care at home on patient symptom burden was studied in the Domus randomised clinical trial. Participants had incurable cancer and limited treatment options. The intervention was provided by specialised palliative home teams (SPT) based in hospice or hospital and was enriched with a psychological intervention for patient and caregiver dyad. Symptom burden was measured with Edmonton Symptom Assessment System (ESAS-r) at baseline, 8 weeks and 6 months follow-up and analysed with mixed models. Survival and place of death was analysed with Kaplan-Meier and Fisher's exact tests. RESULTS The study included 322 patients. Tiredness was significantly improved for the Domus intervention group at 6 months while the other nine symptom outcomes were not significantly different from the control group. Exploring the efficacy of intervention provider demonstrated significant differences in favour of the hospice SPT on four symptoms and total symptom score. Patients with children responded more favourably to the intervention. The long-term follow-up demonstrated no differences between the intervention and the control groups regarding survival or home deaths. CONCLUSIONS The Domus intervention may reduce tiredness. Moreover, the intervention provider and having children might play a role concerning intervention efficacy. The intervention did not affect survival or home deaths. TRIAL REGISTRATION NUMBER NCT01885637.
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Affiliation(s)
- Kirstine Benthien
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Pernille Diasso
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Annika von Heymann
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mie Nordly
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Geana Kurita
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Multidisciplinary Pain Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Helle Timm
- REHPA, The Danish Knowledge Center for Rehabilitation and Palliative Care, University of Southern Denmark, Odense, Denmark
| | - Christoffer Johansen
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jakob Kjellberg
- VIVE Health, VIVE-The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Hans von der Maase
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Per Sjøgren
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Haukland EC, von Plessen C, Nieder C, Vonen B. Adverse events in deceased hospitalised cancer patients as a measure of quality and safety in end-of-life cancer care. BMC Palliat Care 2020; 19:76. [PMID: 32482172 PMCID: PMC7265218 DOI: 10.1186/s12904-020-00579-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 05/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anticancer treatment exposes patients to negative consequences such as increased toxicity and decreased quality of life, and there are clear guidelines recommending limiting use of aggressive anticancer treatments for patients near end of life. The aim of this study is to investigate the association between anticancer treatment given during the last 30 days of life and adverse events contributing to death and elucidate how adverse events can be used as a measure of quality and safety in end-of-life cancer care. METHODS Retrospective cohort study of 247 deceased hospitalised cancer patients at three hospitals in Norway in 2012 and 2013. The Global Trigger Tool method were used to identify adverse events. We used Poisson regression and binary logistic regression to compare adverse events and association with use of anticancer treatment given during the last 30 days of life. RESULTS 30% of deceased hospitalised cancer patients received some kind of anticancer treatment during the last 30 days of life, mainly systemic anticancer treatment. These patients had 62% more adverse events compared to patients not being treated last 30 days, 39 vs. 24 adverse events per 1000 patient days (p < 0.001, OR 1.62 (1.23-2.15). They also had twice the odds of an adverse event contributing to death compared to patients without such treatment, 33 vs. 18% (p = 0.045, OR 1.85 (1.01-3.36)). Receiving follow up by specialist palliative care reduced the rate of AEs per 1000 patient days in both groups by 29% (p = 0.02, IRR 0.71, CI 95% 0.53-0.96). CONCLUSIONS Anticancer treatment given during the last 30 days of life is associated with a significantly increased rate of adverse events and related mortality. Patients receiving specialist palliative care had significantly fewer adverse events, supporting recommendations of early integration of palliative care in a patient safety perspective.
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Affiliation(s)
- Ellinor Christin Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital Trust, PO Box 1480, 8092, Bodø, Norway. .,Institute of Community Medicine, The Arctic University of Norway, PO Box 6, 9038, Tromsø, Norway.
| | - Christian von Plessen
- Direction Générale de la Santé, Canton Vaud, Switzerland.,Unisanté, Direction Générale de la santé, Avenue de Casèrnes 2, 1018, Lausanne, Switzerland.,Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital Trust, PO Box 1480, 8092, Bodø, Norway.,Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Barthold Vonen
- Institute of Community Medicine, The Arctic University of Norway, PO Box 6, 9038, Tromsø, Norway.,Centre for Clinical Documentation and Evaluation, Northern Norway Regional Health Authority, PO Box 6, 9038, Tromsø, Norway
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Toxværd CG, Benthien KS, Andreasen AH, Nielsen A, Osler M, Johansen NB. Chronic Diseases in High-Cost Users of Hospital, Primary Care, and Prescription Medication in the Capital Region of Denmark. J Gen Intern Med 2019; 34:2421-2426. [PMID: 31512179 PMCID: PMC6848743 DOI: 10.1007/s11606-019-05315-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND A small proportion of patients account for the majority of health care costs. This group is often referred to as high-cost users (HCU). A frequently described characteristic of HCU is chronic disease. Yet, there is a gap in understanding the economic burden of chronic diseases associated with HCU to different types of health care services. OBJECTIVE To analyze which frequent chronic diseases have the strongest association with HCU overall, and HCU in hospital, primary care, and prescription medication. DESIGN This is a register-based observational study on Danish health service costs for various diseases in different medical settings. PARTICIPANTS A total of 1,350,677 individuals aged ≥ 18 years living in the Capital Region of Denmark by 1 January 2012 were included. MAIN MEASURES Chronic diseases, costs, and sociodemographic data were extracted from the nationwide registers, including data from hospitals, primary care, and medicine consumption. These information were merged on an individual level. KEY RESULTS Cancer, mental disorders except depression, and heart diseases have the strongest association with HCU overall. Mental disorders except depression were in the three diseases most prevalent in HCU in all the three health care services. CONCLUSIONS Our results show that the chronic diseases that have the strongest association with HCU differ between different types of health care services. Our findings may be helpful in informing future policies about health care organization and may guide to different prevention, treatment, and rehabilitation strategies that could lessen the burden in the hospital.
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Affiliation(s)
- Cecilie Goltermann Toxværd
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
| | - Kirstine Skov Benthien
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Anne Helms Andreasen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Ann Nielsen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Merete Osler
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Section for Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nanna Borup Johansen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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