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Robinson B, Goldstein J, Harrison M, Arab M, Carter A. Paramedics Providing Palliative Care at Home: A Retrospective Cohort Study Comparing Symptom Management of Breathlessness and Pain in Cancer Versus Non-Cancer Conditions. Cureus 2024; 16:e64750. [PMID: 39156272 PMCID: PMC11329185 DOI: 10.7759/cureus.64750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2024] [Indexed: 08/20/2024] Open
Abstract
Background Palliative care aims to alleviate pain and distressing symptoms, affirm life, and offer support to patients and their caregivers. For many, the expressed preference is to die at home. As a result, there is growing recognition that paramedics can play an integral role at the end of life for symptom relief. Paramedic comfort with symptom management in the palliative care context is suspected, based on past work, to be higher for cancer as opposed to non-cancer life advanced disease. The objective of this study was to explore the paramedic management of patients with cancer and non-cancer advanced disease, using pain and breathlessness as key symptoms. Methods A retrospective cohort study was conducted. Paramedic electronic patient care records were queried for calls with palliative goals of care between July 1, 2015, and June 30, 2016, in Nova Scotia, Canada, which was the first year of the Paramedics Providing Palliative Care program. A manual chart review of a subgroup of 100 consecutive charts was completed to gain deeper insight. A descriptive analysis was conducted to understand practice variation within this population. Results The electronic query returned 1909 calls with a palliative approach. A total of 765 (40.1%) had cancer. The most common non-cancer disease category was respiratory. The top chief complaint was respiratory distress in both cancer and non-cancer populations. Medication was administered more often for pain (80%) compared to breathlessness (46.5%). Paramedics were more likely to call Medical Oversight Physicians for pain control advice. Post-treatment pain scores were documented infrequently. In the chart review, symptom management using the patient's own medications occurred in 17% of cases while an additional 5% of cases involved a combination of the patient's medications and paramedic service formulary. Conclusion The non-cancer population was less likely to have a non-transport outcome. Opportunities for improvement of symptom management were noted for pain and particularly so for breathlessness. Increased comfort with a palliative approach in the non-cancer disease cohort as well as with this key symptom will be a key to the success of the program.
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Affiliation(s)
| | | | | | - Marianne Arab
- Cancer Care Program, Nova Scotia Health, Halifax, CAN
| | - Alix Carter
- Emergency Medicine, Dalhousie University, Halifax, CAN
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Roberts HN, Solomon B, Harden S, Lingaratnam S, Alexander M. Utility of 30-Day Mortality Following Systemic Anti-Cancer Treatment as a Quality Indicator in Advanced Lung Cancer. Clin Lung Cancer 2024; 25:e211-e220.e1. [PMID: 38772809 DOI: 10.1016/j.cllc.2024.04.001] [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: 01/02/2024] [Revised: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND 30-day mortality after systemic anti-cancer therapy (SACT) has been suggested as a quality indicator primarily for measuring use of chemotherapy towards the end of life. Utility across different cancer types is unclear, especially when using immunotherapy and targeted therapies. METHODS This retrospective study included patients with a diagnosis of lung cancer who received palliative-intent SACT at an Australian metropolitan cancer center between 2015 and 2022. Using a prospectively maintained lung cancer database, patient, disease, and treatment characteristics were evaluated against annual 30-day mortality rates following SACT. RESULTS 1072 patients were identified. Annual 30-day mortality rate after palliative-intent SACT for lung cancer ranged between 9% and 15%, with significant variance between treatment types. Calculated rates of 30-day mortality are higher if longer reporting time periods are used. Patients who died within 30 days of SACT were more likely to have received targeted therapies or immunotherapy as their final line of treatment, have a poorer performance status at diagnosis, and have received multiple lines of treatment. CONCLUSIONS Our data support differential interpretation of 30-day mortality for quality assurance, especially with regard to lung cancer. Consistency in population and reporting time periods, and accounting for treatment type is crucial if 30-day mortality is to be utilized as cancer care performance quality indicator. Relevance to quality care is questionable in the lung cancer setting.
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Affiliation(s)
| | - Benjamin Solomon
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne VIC 3052, Australia
| | - Susan Harden
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne VIC 3052, Australia
| | - Senthil Lingaratnam
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne VIC 3052, Australia
| | - Marliese Alexander
- Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne VIC 3052, Australia.
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3
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Ali D, Piffoux M. Methodological guide for assessing the carbon footprint of external beam radiotherapy: A single-center study with quantified mitigation strategies. Clin Transl Radiat Oncol 2024; 46:100768. [PMID: 38633470 PMCID: PMC11021844 DOI: 10.1016/j.ctro.2024.100768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/19/2024] [Accepted: 03/23/2024] [Indexed: 04/19/2024] Open
Abstract
Background and purposes Data on the carbon footprint of external beam radiotherapy (EBRT) are scarce. Reliable and exhaustive data, including a detailed carbon inventory, are needed to determine effective mitigation strategies. Materials and methods This study proposes a methodology for calculating the carbon footprint of EBRT and applies it to a single center. Mitigation strategies are derived from the carbon inventory, and their potential reductions are quantified whenever possible. Results The average emission per treatment and fraction delivered was 489 kg CO₂eq and 27 kg CO₂eq, respectively. Patient transportation (43 %) and the construction and maintenance of linear accelerators (LINACs) and scanners (17 %) represented the most significant components. Electricity, the only energy source used, accounted for only 2 % of emissions.Derived mitigation strategies include a data deletion policy (reducing emissions in 30 years by 12.5 %), geographical appropriateness (-12.2 %), transportation mode appropriateness (-9.3 %), hypofractionation (-5.9 %), decrease in manufacturers' carbon footprint (-5.2 %), and an increase in machine durability (-3.5 %). Conclusion Our findings indicate that a significant reduction in the carbon footprint of a radiotherapy unit can be achieved without compromising the quality of care.This study provides a methodology and a starting point for comparison and proposes and quantifies mitigation strategies, paving the way for others to follow.
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Affiliation(s)
- David Ali
- Centre de Radiothérapie et de Traitement des Tumeurs, Versailles, France
| | - Max Piffoux
- Département d’Oncologie Médicale, Hospices Civils de Lyon, CITOHL, Lyon, France
- Direction de la Recherche Clinique et de l’Innovation, Centre Léon Bérard, Lyon, France
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Golob N, Oblak T, Čavka L, Kušar M, Šeruga B. Aggressive anticancer treatment in the last 2 weeks of life. ESMO Open 2024; 9:102937. [PMID: 38471241 PMCID: PMC10944113 DOI: 10.1016/j.esmoop.2024.102937] [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: 11/30/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND There is a concern that terminally ill cancer patients may be aggressively treated due to the rapidly growing possibilities of anticancer treatment. The aim of this study was to evaluate the use of anticancer treatment at the end of life (EoL). MATERIALS AND METHODS This retrospective study included adult patients with advanced solid cancers who were treated at the Institute of Oncology Ljubljana and died of cancer between January 2015 and December 2019. A multiple logistic regression model was used to assess an association between the aggressiveness of anticancer treatment (i.e. systemic therapy, radiotherapy and surgery) in the last 2 weeks of life and year of death, age at death, sex, prognosis of cancer and enrolment into the specialist palliative care (SPC). RESULTS We included 1736 patients in our analysis. Overall, 13.7% of patients were enrolled into the SPC and 14.4% received anticancer treatment in the last 2 weeks of life. The odds of receiving anticancer treatment significantly increased over time [odds ratio (OR) 1.15, 95% confidence interval (CI) 1.04-1.27]. There was an increased use of novel systemic therapy (e.g. small-molecule targeted therapy and immunotherapy) at the EoL. Older patients had significantly lower odds to receive anticancer treatment in the last 2 weeks of life as compared to younger patients (OR 0.96, 95% CI 0.95-0.98). As compared to patients receiving only a standard oncology care, those also enrolled into the SPC had significantly lower odds for anticancer treatment in the last 2 weeks of life (OR 0.22, 95% CI 0.12-0.43). CONCLUSIONS Terminally ill cancer patients have increased odds for receiving anticancer treatment, especially novel systemic therapies, in the last 2 weeks of life. Younger patients and those not enrolled into the SPC are at particular risk for anticancer treatment at the EoL.
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Affiliation(s)
- N Golob
- Faculty of Medicine, University of Ljubljana, Ljubljana; Department of Acute Palliative Care, Institute of Oncology Ljubljana, Ljubljana
| | - T Oblak
- Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana
| | - L Čavka
- Faculty of Medicine, University of Ljubljana, Ljubljana; Department of Oncology, University Medical Center Maribor, Maribor
| | - M Kušar
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana
| | - B Šeruga
- Faculty of Medicine, University of Ljubljana, Ljubljana; Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
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Chiang JK, Kao HH, Kao YH. Factors Associated with Hospitalized Community-Acquired Pneumonia among Elderly Patients Receiving Home-Based Care. Healthcare (Basel) 2024; 12:443. [PMID: 38391817 PMCID: PMC10887704 DOI: 10.3390/healthcare12040443] [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: 01/11/2024] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
(1) Background: Pneumonia stands as a prevalent infectious disease globally, contributing significantly to mortality and morbidity rates. In Taiwan, pneumonia ranks as the third leading cause of death, particularly affecting the elderly population (92%). This study aims to investigate factors associated with community-acquired pneumonia (CAP) among elderly individuals receiving home-based care. (2) Methods: Conducted between January 2018 and December 2019, this retrospective study involved a medical chart review of elderly patients under home-based care. A multiple logistic regression model was employed to identify factors associated with CAP in this demographic. (3) Results: Analysis encompassed 220 elderly patients with an average age of 82.0 ± 1.1 years. Eighty-five patients (38.6%) were hospitalized for CAP. Predominant diagnoses included cancer (32.3%), stroke (24.5%), and dementia (23.6%). Significant predictors of CAP for elderly patients under home-based care included male gender (odds ratio [OR] = 4.10, 95% confidence interval [CI]: 1.95-8.60, p < 0.001), presence of a nasogastric (NG) tube (OR = 8.85, 95% CI: 3.64-21.56, p < 0.001), and a borderline negative association with the use of proton pump inhibitors (PPIs) (OR = 0.37, 95% CI: 0.13-1.02, p = 0.0546). End-of-life care indicators for these patients with CAP included an increased number of hospital admission days in the last month of life (OR = 1.13, 95% CI: 1.08-1.18, p < 0.001) and a higher likelihood of hospital death (OR = 3.59, 95% CI: 1.51-8.55, p = 0.004). (4) Conclusions: In the current study, significant predictors of CAP among elderly patients receiving home-based care included the presence of an NG tube and male gender, while the use of PPIs was borderline inversely associated with the risk of CAP. Notably, more admission days in the last month of life and death in the hospital were found to be associated with end-of-life care for this group.
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Affiliation(s)
- Jui-Kun Chiang
- Department of Family Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Road, Dalin, Chiayi 622, Taiwan
| | - Hsueh-Hsin Kao
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung 40201, Taiwan
| | - Yee-Hsin Kao
- Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), 670 Chung-Te Road, Tainan 701, Taiwan
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Chang A, Espinosa J, Lucerna A. Emergency Department Management of Common End-of-Life and Palliative Care Symptoms: Three Cases. Cureus 2024; 16:e53538. [PMID: 38445127 PMCID: PMC10912970 DOI: 10.7759/cureus.53538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/07/2024] Open
Abstract
The emergency department (ED) is at times the only place where patients can turn for symptom relief. Patients of all ages may turn to the ED for help with the management of end-of-life (EOL) and palliative care (PC) symptoms. Emergency medicine (EM) is a specialty that manages disease-directed treatment for a variety of acute conditions. In contrast, EOL and PC are focused on improving quality of life. Patients with serious illness, even hospice patients, present to the ED in increasing numbers for symptom management. It has become essential for emergency physicians to care for patients who are not seeking life-sustaining measures but instead need quality-of-life interventions. The development of a clear, concise review of the most common acute symptoms can provide a framework for EM physicians to adequately address the needs of patients at the EOL. Here, we discuss three cases that highlight the management of five of the most common EOL and PC presentations to the ED.
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Affiliation(s)
- Alice Chang
- Emergency Medicine, Jefferson Health New Jersey, Stratford, USA
| | - James Espinosa
- Emergency Medicine, Jefferson Health New Jersey, Stratford, USA
| | - Alan Lucerna
- Emergency Medicine, Jefferson Health New Jersey, Stratford, USA
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7
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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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8
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Hegagi M, James P, Hsu A, Tanuseputro P. Home Care Use and Out-of-Hospital Death in Pancreatic Cancer Patients: A Retrospective Cohort Study. J Palliat Care 2023; 38:175-183. [PMID: 35179424 DOI: 10.1177/08258597221075088] [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: 11/15/2022]
Abstract
Objective: This study aimed to determine the factors associated with usage of home care, including palliative home care, in patients with pancreatic cancer in Ontario. In addition, this study attempted to investigate factors associated with early-onset palliative home care as well as the impact of home care services on survival and out-of-hospital death. Methods: The Ontario Cancer Registry (OCR) was used to identify and capture basic patient/cancer characteristics of index cases of pancreatic cancer diagnosed between April first, 2010 and March 31st, 2016. Patients that received home care were identified using the Home Care Database (HCD) and stratified into general, transition-to-palliative, and early-onset palliative home care. Logistic regressions were used to describe determinants of home care use and determinants of out-of-hospital death. Results: A total of 6888 pancreatic cancer patients met eligibility criteria for this study. A high proportion of patients (83.7%) received home care, including palliative home care (56.8%). In general, older patients (OR = 3.07) and those with more advanced malignancy (OR = 4.98) for stage 4 versus stage 1) had greater odds of receiving palliative home care. Patients receiving home care (P < .01) and those residing in rural regions (P < .01) had greater odds of out-of-hospital death. Conclusion: A large proportion of patients with pancreatic cancer are directed to home care and those that do are more likely to die outside of hospital. Age and stage at diagnosis are significant predictors of home care use. Differences exist in the healthcare experience of patients depending on if they receive home care services and the type of home care.
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Affiliation(s)
- Mehdi Hegagi
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Paul James
- Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluation Sciences, Cancer Research Program, Toronto, Ontario, Canada
| | - Amy Hsu
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- ICES, Population Health and Primary Care, Ottawa, Ontario, Canada
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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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Muacevic A, Adler JR, Rei S, Pinto R, Freitas S, Camacho G, Gonçalves Y, Gouveia M, Gomes M. Evaluation of the Needs for Palliative Care in Madeira Island: A Pre-pandemic Overview. Cureus 2023; 15:e34793. [PMID: 36788996 PMCID: PMC9918327 DOI: 10.7759/cureus.34793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 02/11/2023] Open
Abstract
Introduction As general practitioners/family physicians, it is our duty to promote health and prevent disease by providing cure, care, or palliation. Palliative care (PC) plays a crucial role in integrated and patient-centered health services. In the Autonomous Region of Madeira (RAM), Portugal, the PC Unit (PCU) was established in 2012. According to data from 2010, 41.2% of individuals who passed away in this region had a requirement for PC. Our objective is to determine the potential needs for PC in our population in the year 2019, prior to the pandemic. Additionally, we aim to determine the main indications for PC and the number of emergency department admissions/hospitalizations and compare these needs with data from 2010. Methods We conducted an observational, cross-sectional, and descriptive, analytical study, in which the target population consisted of all individuals who passed away in RAM in the year 2019. From this population, a representative sample of deceased individuals was obtained. The gender, age, disease with a potential indication for palliative care, admissions to emergency care and hospitalizations in the preceding 12 months, and county of residence were obtained from the RAM Health Services and analyzed using Microsoft Excel (Microsoft Corp., Redmond, WA, USA) and the Statistical Package for the Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY, USA) software. Results From the total number of individuals who passed away in RAM in the year 2019 (N=2,840), a representative sample of 339 deceased individuals was obtained. Of the deceased individuals, 56% presented with potential indications for palliative care, compared to the 41.2% result recorded in 2010 (p<0.0001). Among these individuals, 51.9% were female, and the average age was 79.7±12.2 years. Neoplasms were the primary indication for palliative care, accounting for 22.7%. Individuals with potential indications for PC, when compared to those without indications, had a higher number of hospitalizations and emergency episodes in the preceding 12 months (p=0.0005 and p=0.008, respectively). Conclusion We conclude that over half of the patients who passed away in RAM had potential indications for palliative care. These individuals experienced a higher number of hospitalizations and emergency episodes in the preceding 12 months. In this study, we also observed a significant increase in the need for palliative care compared to the year 2010.
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Hafid A, Howard M, Webber C, Gayowsky A, Scott M, Jones A, Hsu AT, Tanuseputro P, Downar J, Conen K, Manuel D, Isenberg SR. Describing settings of care in the last 100 days of life for cancer decedents: a population-based descriptive study. Cancer Med 2023; 12:4809-4820. [PMID: 36281530 PMCID: PMC9972173 DOI: 10.1002/cam4.5291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/24/2022] [Accepted: 09/13/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Few studies have described the settings cancer decedents spend their end-of-life stage, with none considering homecare specifically. We describe the different settings of care experienced in the last 100 days of life by individuals with cancer and how settings of care change as they approached death. METHODS A retrospective cohort study from January 2013 to December 2017, of decedents whose primary cause of death was cancer, using linked population-level health administrative datasets in Ontario, Canada. RESULTS Decedents 125,755 were included in our cohort. The average age at death was 73, 46% were female, and 14% resided in rural regions. And 24% died of lung cancer, 7% breast, 7% colorectal, 7% pancreatic, 5% prostate, and 50% other cancers. In the last 100 days of life, decedents spent 25.9 days in institutions, 25.8 days receiving care in the community, and 48.3 days at home without any care. Individuals who died of lung and pancreatic cancers spent the most days at home without any care (52.1 and 52.6 days), while individuals who died of prostate and breast cancer spent the least days at home without any care (41.6 and 45.1 days). Regardless of cancer type, decedents spent fewer days at home and more days in institutions as they approached death, despite established patient preferences for an end-of-life experience at home. CONCLUSIONS In the last 100 days of life, cancer decedents spent most of their time in either institutions or at home without any care. Improving homecare services during the end-of-life may provide people dying of cancer with a preferred dying experience.
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Affiliation(s)
- Abe Hafid
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Colleen Webber
- Ottawa Hospital Research Institute, Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada.,ICES uOttawa, Ottawa, Canada
| | | | - Mary Scott
- Ottawa Hospital Research Institute, Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada
| | - Aaron Jones
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Amy T Hsu
- Ottawa Hospital Research Institute, Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada.,ICES uOttawa, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - James Downar
- Ottawa Hospital Research Institute, Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Katrin Conen
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Doug Manuel
- Ottawa Hospital Research Institute, Ottawa, Canada.,ICES uOttawa, Ottawa, Canada.,Department of Family Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Sarina R Isenberg
- Ottawa Hospital Research Institute, Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Canada
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Wang CL, Lin CY, Yang SF. Hospice Care Improves Patients' Self-Decision Making and Reduces Aggressiveness of End-of-Life Care for Advanced Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15593. [PMID: 36497668 PMCID: PMC9735887 DOI: 10.3390/ijerph192315593] [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: 10/07/2022] [Revised: 11/10/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
The aim of the current study is to evaluate the different degrees of hospice care in improving patients' autonomy in decision-making and reducing aggressiveness of cancer care in terminal-stage cancer patients, especially in reducing polypharmacy and excessive life-sustaining treatments. This was a retrospective cross-sectional study conducted in a single medical center in Taiwan. Patients with advanced cancer who died in 2010-2019 were included and classified into three subgroups: hospice ward admission, hospice shared care, and no hospice care involvement. In total, 8719 patients were enrolled, and 2097 (24.05%) admitted to hospice ward; 2107 (24.17%) received hospice shared care, and 4515 (51.78%) had no hospice care. Those admitted to hospice ward had significantly higher rates of having completed do-not-resuscitate order (100%, p < 0.001) and signed the do-not-resuscitate order by themselves (48.83%, p < 0.001), and they had lower aggressiveness of cancer care (2.2, p < 0.001) within the 28 days before death. Hospice ward admission, hospice shared care, and age > 79 years were negatively associated with aggressiveness of cancer care. In conclusion, our study showed that patients with end-of-life hospice care related to higher patient autonomy in decision-making and less excessively aggressive cancer care; the influence of care was more overt in patients approaching death. Further clinical efforts should be made to clarify the patient and the families' satisfaction and perceptions of quality after hospice care involvement.
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Affiliation(s)
- Chun-Li Wang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Chia-Yen Lin
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan
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Atodaria KP, Cohen SJ, Dhruv S, Ginnaram SR, Shah S. Trends in Palliative Care, Hospice Utilization, and Outcomes in Hospitalized Pancreatic Cancer Patients: A Nationwide Analysis. Cureus 2022; 14:e29351. [DOI: 10.7759/cureus.29351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 11/05/2022] Open
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Chiang JK, Kao YH. Factors associated with death places among elderly patients receiving home-based care. Medicine (Baltimore) 2022; 101:e29630. [PMID: 35905239 PMCID: PMC9333526 DOI: 10.1097/md.0000000000029630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The quality of end-of-life (EOL) care for patients receiving home-based care is a critical issue for health care providers. Dying in a preferred place is recognized as a key EOL care quality indicator. We explore the factors associated with death at home or nursing facilities among elderly patients receiving home-based care. This retrospective study was based on a medical chart review between January 2018 and December 2019 of elderly patients. Multivariate analysis was conducted by fitting multiple logistic regression models with the stepwise variable selection procedure to explore the associated factors. The 205 elderly patients receiving home-based care were enrolled for analysis. The mean participant age was 84.2 ± 7.8 years. Multiple logistic regression indicated that significant factors for elderly home-based patients who died at home or nursing facilities were receiving palliative service (odds ratio [OR], 3.21; 95% confidence interval [CI], 1.37-7.51; P = .007), symptoms of nausea or vomiting (OR, 5.38; 95% CI, 1.12-25.84; P = .036), fewer emergency department visits (OR, 0.07; 95% CI, 0.03-0.16; P < .001), and less intravenous third-generation cephalosporin use (OR, 0.15; 95% CI, 0.03-0.75; P = .021) in the last month of life. Patients with dementia had a lower probability of dying at home or nursing facilities than patients with other diagnosis (OR, 0.34, 95% CI, 0.13-0.90; P = .030). Among elderly home-based patients, receiving palliative service, with nausea or vomiting, and fewer emergency department visits in the last month of life favored home or nursing facilities deaths. Practitioners should be aware of the factors with higher probabilities of dying at home and in nursing facilities. We suggested that palliative services need to be further developed and extended to ensure that patients with dementia can receive adequate EOL care at home and in nursing facilities.
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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 (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan
- *Correspondence: Yee-Hsin Kao, Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), 670 Chung Te Road, Tainan 70173, Taiwan (e-mail: )
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15
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Koch M, Varga C, Soós V, Prenek L, Porcsa L, Szakáll A, Bilics G, Hunka B, Bellyei S, Girán J, Kiss I, Pozsgai É. Main reasons and predictive factors of cancer-related emergency department visits in a Hungarian tertiary care center. BMC Emerg Med 2022; 22:114. [PMID: 35739467 PMCID: PMC9219147 DOI: 10.1186/s12873-022-00670-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identifying the reasons for the Emergency Department (ED) visit of patients with cancer would be essential for possibly decreasing the burden of ED use. The aim of our study was to analyze the distribution of the demographic and clinical parameters of patients with cancer based on the reasons for the ED visits and to identify possible predictive factors for their visits. METHODS This retrospective study, carried out at a large, public tertiary hospital in Hungary, involved all patients 18 years or over, who had received a cancer diagnosis latest within five years of their visit to the ED in 2018. Demographic and clinical characteristics were collected partly via automated data collection and partly through the manual chart review by a team of experts, including six emergency physicians and an oncologist. Five main reasons for the ED visit were hypothesized, pilot-tested, then identified, including those with cancer-related ED visits (whose visit was unambiguously related to their cancer illness) and those with non-cancer-related ED visits (whose visit to the ED was in no way associated with their cancer illness.) A descriptive approach was used for data analysis and binary logistic regression was used to determine predictive factors for patients with cancer visiting the ED. RESULTS 23.2% of the altogether 2383 ED visits were directly cancer-related, and these patients had a significantly worse overall survival than patients with non-cancer related ED visits. Age 65 or below (Odds Ratio: 1.51), presence of two more comorbidities (OR: 7.14), dyspnea as chief complaint (OR: 1.52), respiratory cancer (OR: 3.37), any prior chemotherapy (OR: 1.8), any prior immune/biological treatment (OR: 2.21), any prior Best Supportive Care/palliative care (OR: 19.06), or any prior hospice care (OR: 9.43), and hospitalization (OR:2.88) were independent risk factors for the ED visit to be cancer-related. CONCLUSIONS Our study is the first to identify independent predictive factors of ED use by patients with cancer based on the chief cause of their visit in the Central and Eastern European region. These results may provide important information for the development of algorithms intended to identify the needs of care of patients with cancer at the ED.
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Affiliation(s)
- Márton Koch
- Department of Emergency Medicine, Somogy County Kaposi Mór General Hospital, Tallián Gyula Street 20-32, Kaposvár, 7400, Hungary
| | - Csaba Varga
- Department of Emergency Medicine, Somogy County Kaposi Mór General Hospital, Tallián Gyula Street 20-32, Kaposvár, 7400, Hungary.,Department of Emergency Medicine, Semmelweis University, Üllői Street 78/A, Budapest, 1082, Hungary
| | - Viktor Soós
- Department of Emergency Medicine, Somogy County Kaposi Mór General Hospital, Tallián Gyula Street 20-32, Kaposvár, 7400, Hungary
| | - Lilla Prenek
- Department of Emergency Medicine, Somogy County Kaposi Mór General Hospital, Tallián Gyula Street 20-32, Kaposvár, 7400, Hungary
| | - Lili Porcsa
- Department of Emergency Medicine, Somogy County Kaposi Mór General Hospital, Tallián Gyula Street 20-32, Kaposvár, 7400, Hungary
| | - Alíz Szakáll
- Department of Emergency Medicine, Somogy County Kaposi Mór General Hospital, Tallián Gyula Street 20-32, Kaposvár, 7400, Hungary
| | - Gergely Bilics
- Department of Emergency Medicine, Somogy County Kaposi Mór General Hospital, Tallián Gyula Street 20-32, Kaposvár, 7400, Hungary.,Department of Emergency Medicine, Semmelweis University, Üllői Street 78/A, Budapest, 1082, Hungary
| | - Balázs Hunka
- Department of Emergency Medicine, Somogy County Kaposi Mór General Hospital, Tallián Gyula Street 20-32, Kaposvár, 7400, Hungary
| | - Szabolcs Bellyei
- Department of Oncotherapy, University of Pécs Clinical Center, Édesanyák Street 17, Pécs, 7624, Hungary
| | - János Girán
- Department of Public Health Medicine, University of Pécs Medical School, Szigeti Street 12, Pécs, 7624, Hungary
| | - István Kiss
- Department of Public Health Medicine, University of Pécs Medical School, Szigeti Street 12, Pécs, 7624, Hungary
| | - Éva Pozsgai
- Department of Public Health Medicine, University of Pécs Medical School, Szigeti Street 12, Pécs, 7624, Hungary. .,Department of Primary Health Care, University of Pécs Medical School, Rákóczi Street 2, Pécs, 7623, Hungary.
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16
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Dahiya DS, Inamdar S, Perisetti A, Kichloo A, Singh A, Solanki S, Solanki D, Al-Haddad M. Decreasing length of stay and inpatient mortality associated with pancreatic cancer hospitalizations: A United States national survey from 2008 to 2017. Pancreatology 2022; 22:590-597. [PMID: 35469754 DOI: 10.1016/j.pan.2022.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/30/2022] [Accepted: 04/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND/OBJECTIVES Pancreatic cancer is the third leading cause of cancer death in the United States (US). However, there is paucity of data on pancreatic cancer hospitalizations in the US. METHODS We analyzed the National Inpatient Sample (NIS) to identify all hospitalizations of pancreatic cancer from 2008 to 2017. Hospitalization characteristics, adverse outcomes, and the disease burden on the US healthcare system was highlighted and further analyzed with respect to the US population. P-values ≤0.05 were statistically significant. RESULTS We noted an increase in the total number of pancreatic cancer hospitalizations from 37,123 in 2008 to 37,635 in 2017 (p < 0.0001), but a decline was noted for per million US population from 122 in 2008 to 116 in 2017. The 65-79 age group had the highest hospitalizations with an increasing trend from 41.6% in 2008 to 45.9% in 2017 (p < 0.0001). In 2008, a slight female predominance was noted (51.9 vs 48.1%, p < 0.0001); however, in 2017, a slight male predominance was observed (50.9 vs 49.1%, p < 0.0001). Whites made up a majority of the study population. Furthermore, emergent/urgent hospitalizations (50.7 vs 49.3%, p < 0.0001) were slightly more frequent than elective hospitalizations in 2017. The mean length of stay (LOS) decreased from 8.4 days in 2008 to 7 days in 2017 (p < 0.0001) and the all-cause inpatient mortality decreased from 10.1% in 2008 to 7.6% in 2017 (p < 0.0001). CONCLUSION Although the total number of pancreatic cancer hospitalizations increased, there was a decline for per million US population. Additionally, mean LOS and inpatient mortality decreased between 2008 and 2017.
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Affiliation(s)
- Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA.
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | | | - Asim Kichloo
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA.
| | - Amandeep Singh
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Shantanu Solanki
- Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, PA, USA.
| | | | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
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Guthrie DM, Williams N, Beach C, Buzath E, Cohen J, Declercq A, Fisher K, Fries BE, Goodridge D, Hermans K, Hirdes JP, Seow H, Silveira M, Sinnarajah A, Stevens S, Tanuseputro P, Taylor D, Vadeboncoeur C, Martin TLW. A multi-stage process to develop quality indicators for community-based palliative care using interRAI data. PLoS One 2022; 17:e0266569. [PMID: 35390091 PMCID: PMC8989210 DOI: 10.1371/journal.pone.0266569] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Individuals receiving palliative care (PC) are generally thought to prefer to receive care and die in their homes, yet little research has assessed the quality of home- and community-based PC. This project developed a set of valid and reliable quality indicators (QIs) that can be generated using data that are already gathered with interRAI assessments—an internationally validated set of tools commonly used in North America for home care clients. The QIs can serve as decision-support measures to assist providers and decision makers in delivering optimal care to individuals and their families.
Methods
The development efforts took part in multiple stages, between 2017–2021, including a workshop with clinicians and decision-makers working in PC, qualitative interviews with individuals receiving PC, families and decision makers and a modified Delphi panel, based on the RAND/ULCA appropriateness method.
Results
Based on the workshop results, and qualitative interviews, a set of 27 candidate QIs were defined. They capture issues such as caregiver burden, pain, breathlessness, falls, constipation, nausea/vomiting and loneliness. These QIs were further evaluated by clinicians/decision makers working in PC, through the modified Delphi panel, and five were removed from further consideration, resulting in 22 QIs.
Conclusions
Through in-depth and multiple-stakeholder consultations we developed a set of QIs generated with data already collected with interRAI assessments. These indicators provide a feasible basis for quality benchmarking and improvement systems for care providers aiming to optimize PC to individuals and their families.
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Affiliation(s)
- Dawn M. Guthrie
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
- * E-mail:
| | - Nicole Williams
- Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Cheryl Beach
- Integrated Community Services, Fraser Health, Surrey, British Columbia, Canada
| | - Emma Buzath
- Provincial Palliative and-End-of-Life Care, Seniors Health and Continuing Care, Alberta Health Services, Calgary, Alberta, Canada
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Anja Declercq
- LUCAS – Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium
- CESO – Center for Sociological Research, KU Leuven, Leuven, Belgium
| | - Kathryn Fisher
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Brant E. Fries
- Department of Health Management and Policy and Department of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Donna Goodridge
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kirsten Hermans
- LUCAS – Center for Care Research and Consultancy, KU Leuven, Leuven, Belgium
| | - John P. Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Maria Silveira
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
| | | | - Susan Stevens
- Nova Scotia Health, Halifax, Halifax, Nova Scotia, Canada
| | - Peter Tanuseputro
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Deanne Taylor
- Research Department, Interior Health Authority, Kelowna, British Columbia, Canada
- Rural Coordination Centre of BC, Penticton, British Columbia, Canada
| | - Christina Vadeboncoeur
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario Ottawa, Ontario, Canada
- Roger Neilson House, Ottawa, Ontario, Canada
| | - Tracy Lyn Wityk Martin
- Provincial Palliative and-End-of-Life Care, Seniors Health and Continuing Care, Alberta Health Services, Calgary, Alberta, Canada
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18
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Eggen AC, Hospers GAP, Bosma I, Kramer MCA, Reyners AKL, Jalving M. Anti-tumor treatment and healthcare consumption near death in the era of novel treatment options for patients with melanoma brain metastases. BMC Cancer 2022; 22:247. [PMID: 35247992 PMCID: PMC8897874 DOI: 10.1186/s12885-022-09316-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 02/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background Effective systemic treatments have revolutionized the management of patients with metastatic melanoma, including those with brain metastases. The extent to which these treatments influence disease trajectories close to death is unknown. Therefore, this study aimed to gain insight into provided treatments and healthcare consumption during the last 3 months of life in patients with melanoma brain metastases. Methods Retrospective, single-center study, including consecutive patients with melanoma brain metastases diagnosed between June-2015 and June-2018, referred to the medical oncologist, and died before November-2019. Patient and tumor characteristics, anti-tumor treatments, healthcare consumption, presence of neurological symptoms, and do-not-resuscitate status were extracted from medical charts. Results 100 patients were included. A BRAF-mutation was present in 66 patients. Systemic anti-tumor therapy was given to 72% of patients during the last 3 months of life, 34% in the last month, and 6% in the last week. Patients with a BRAF-mutation more frequently received systemic treatment during the last 3 (85% vs. 47%) and last month (42% vs. 18%) of life than patients without a BRAF-mutation. Furthermore, patients receiving systemic treatment were more likely to visit the emergency room (ER, 75% vs. 36%) and be hospitalized (75% vs. 36%) than those who did not. Conclusion The majority of patients with melanoma brain metastases received anti-tumor treatment during the last 3 months of life. ER visits and hospitalizations occurred more often in patients on anti-tumor treatment. Further research is warranted to examine the impact of anti-tumor treatments close to death on symptom burden and care satisfaction.
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Hiramoto S, Taniyama T, Kikuchi A, Hori T, Yoshioka A, Inoue A. Effects of molecular targeting agents and immune-checkpoint inhibitors in patients with advanced cancer who are near the end of life. Palliat Support Care 2021; 19:709-714. [PMID: 33729120 DOI: 10.1017/s147895152100002x] [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] [Indexed: 02/02/2023]
Abstract
BACKGROUND In recent years, the use of both molecular targeting agents (MTAs) and immune-checkpoint inhibitors (ICIs) tend to occupy important positions in systemic anticancer therapy (SACT). The objective of this study is to describe the predictors of SACT include both MTAs and ICIs near the end of life (EOL) and the effect on EOL care in patients with advanced cancer. METHODS We analyzed all patients who died of advanced cancer from August 2016 to August 2019, and we analyzed the survival time of patients who underwent anticancer agents excluded due to the loss of information about the last administration of SACT. The primary endpoint of this study was to identify predictors during the last administration of SACT near EOL. RESULTS In a multivariate analysis, the Eastern Cooperative Oncology Group performance status (ECOG-PS) (ORs 33.781) was significantly related factors within 14 days of death from the last administration of SACT. Age (ORs 0.412), ECOG-PS (ORs 11.533), primary cancer site of upper GI cancers (ORs 2.205), the number of comorbidities (ORs 0.207), MTAs (ORs 3.139), and ICIs (ORs 3.592) were significantly related factors within 30 days of death. The median survival time (MST) of patients with PS 3-4 was 29 days, while that of patients with both PS 0-2 was 76 days. The prevalence rate of delirium with MTAs was 17.5%, which was significantly lower than that of patients without it (31.8%). The prevalence rate of the mean dose of opioids in patients with ICIs was 97.9 mg/day, which was significantly higher than that of patients without it (44.9 mg/day). CONCLUSIONS Age, ECOG-PS, primary cancer site, the number of comorbidities, MTAs, and ICIs use were significant associated with SACT near EOL. Information on these factors may aid clinical decision making in referral to palliative care institutes.
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Affiliation(s)
- Shuji Hiramoto
- Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital Japan, Kyoto, Japan
| | - Tomohiko Taniyama
- Department of Clinical Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Ayako Kikuchi
- Department of Clinical Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Tetsuo Hori
- Department of Clinical Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Akira Yoshioka
- Department of Clinical Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
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Improving end-of-life care in the emergency department: Development of a standardized approach to an imminently dying patient. CAN J EMERG MED 2021; 22:626-628. [PMID: 32390579 DOI: 10.1017/cem.2020.355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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21
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What should be measured to assess the quality of community-based palliative care? Results from a collaborative expert workshop. Palliat Support Care 2021; 20:226-232. [PMID: 34154690 DOI: 10.1017/s1478951521000791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The need for palliative care (PC) will continue to increase in Canada with population aging. Many older adults prefer to "age in place" and receive care in their own homes. Currently, there is a lack of standardized quality indicators (QIs) for PC delivered in the community in Canada. METHODS A one-day workshop collected expert opinions on what should be measured to capture quality PC. Three brainstorming sessions were focused on addressing the following questions: (1) what is important to measure to support quality PC, regardless of setting? (2) Of the identified measures, are any of special importance to care provided in the home? (3) What are the challenges, barriers, and opportunities for creating these measures? The National Consensus Project (NCP) for Quality Palliative Care framework was used as a guide to group together important comments into key themes. RESULTS The experts identified four themes that are important for measuring quality, regardless of care setting, including access to care in the community by a multidisciplinary team, care for the individual with PC needs, support for the informal caregiver (e.g., family, friends), and symptom management for individuals with PC needs. Two additional themes were of special importance to measuring quality PC in the home, including spiritual care for individuals with PC needs and home as the preferred place of death. The challenges, barriers, and potential opportunities to these quality issues were also discussed. SIGNIFICANCE OF RESULTS PC experts, through this collaborative process, made a substantial contribution to the creation of a standardized set of QIs for community-based PC. Having a standardized set of QIs will enable health care professionals and decision makers to target areas for improvement, implement interventions to improve the quality of care, and ultimately, optimize the health and well-being of individuals with a serious illness.
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22
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Takayama H, Kawahara K, Fushimi K. Relationship between pre-hospitalization home-based medical care of elderly patients who died from pneumonia and inpatient aggressive therapy in Japan. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1919046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Hayato Takayama
- Department of Health Policy Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
- Reginal Medical Support Center, Nagasaki University Hospital, Japan
| | - Kazuo Kawahara
- Department of Health Policy Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
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Chiang JK, Kao YH. Quality of end-of-life care of home-based care with or without palliative services for patients with advanced illnesses. Medicine (Baltimore) 2021; 100:e25841. [PMID: 33950997 PMCID: PMC8104190 DOI: 10.1097/md.0000000000025841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/19/2021] [Indexed: 01/04/2023] Open
Abstract
Palliative care has improved quality of end-of-life (EOL) care for patients with cancer, and these benefits may be extended to patients with other serious illnesses. EOL care quality for patients with home-based care is a critical problem for health care providers. We compare EOL quality care between patients with advanced illnesses receiving home-based care with and without palliative services.The medical records of deceased patients who received home-based care at a community teaching hospital in south Taiwan from January to December 2019 were collected retrospectively. We analyzed EOL care quality indicators during the last month of life.A total of 164 patients were included for analysis. Fifty-two (31.7%) received palliative services (HP group), and 112 (68.3%) did not receive palliative services (non-HP group). Regarding the quality indicators of EOL care, we discovered that a lower percentage of the HP group died in a hospital than did that of the non-HP group (34.6% vs 62.5%, P = .001) through univariate analysis. We found that the HP group had lower scores on the aggressiveness of EOL care than did the non-HP group (0.5 ± 0.9 vs 1.0 ± 1.0, P<.001). Furthermore, palliative services were a significant and negative factor of dying in a hospital after adjustment (OR = 0.13, 95%CI = 0.05-0.36, P < .001).For patients with advanced illnesses receiving home-based care, palliative services are associated with lower scores on the aggressiveness of EOL care and a reduced probability of dying in a hospital.
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Affiliation(s)
- Jui-Kun Chiang
- Department of Family Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chiayi
| | - Yee-Hsin Kao
- Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan
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Mostarac I, Barbera L, Sussman J, Dainty K, Wu L, Ratcliffe J, Atzema CL. I'm here because I was told to come: a study of cancer patients' reasons for attending the emergency department. Support Care Cancer 2021; 29:6565-6578. [PMID: 33913007 DOI: 10.1007/s00520-021-06215-8] [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: 12/19/2020] [Accepted: 04/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Patients with cancer are seen frequently in emergency departments (EDs). It has been proposed that many of these visits are preventable, but the patient perspective has not been well-studied. METHODS We conducted structured interviews with a convenience sample of patients who presented to a single ED with a cancer-related complaint. We asked standardized questions regarding patient predisposing characteristics, enabling factors (e.g., access to support), and perceived need for care. We compared the reported perceived need with the evaluated need by ED healthcare providers. Themes were identified using descriptive content analysis. RESULTS Forty-five patients completed interviews, of whom 30 (67%) were admitted to hospital. The most frequent reasons for seeking ED care were pain (includes abdominal) (33%), fever (11%), and weakness (11%). The majority (77%) did not make the decision to go to the ED alone: healthcare providers (40%, most commonly oncologists) and caregivers (36%) were the reported decision-makers in these cases. The majority (73%) felt their ED visit was not preventable. Themes of an alternative oncological setting for tests, improved community services, and both earlier medication management and referral to specialist care were identified from patients who reported their visit was avoidable. Congruence between (patient) perceived need and evaluated need was high (96%). CONCLUSIONS The minority of patients made the decision to seek ED care by themselves. While the majority did not believe emergency care was avoidable, those who did had cogent suggestions to that end. Patient's assessments of their own need had high agreement with ED providers' evaluations.
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Affiliation(s)
- Ivona Mostarac
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
| | - Lisa Barbera
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,ICES, Toronto, ON, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.,Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
| | - Jonathan Sussman
- Department of Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Katie Dainty
- The Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,North York General Hospital, Toronto, ON, Canada
| | - Libo Wu
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Jenna Ratcliffe
- Department of Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Clare L Atzema
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,ICES, Toronto, ON, Canada.,The Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
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25
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Earp M, Cai P, Fong A, Blacklaws K, Pham TM, Shack L, Sinnarajah A. Hospital-based acute care in the last 30 days of life among patients with chronic disease that received early, late or no specialist palliative care: a retrospective cohort study of eight chronic disease groups. BMJ Open 2021; 11:e044196. [PMID: 33762238 PMCID: PMC7993357 DOI: 10.1136/bmjopen-2020-044196] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE For eight chronic diseases, evaluate the association of specialist palliative care (PC) exposure and timing with hospital-based acute care in the last 30 days of life. DESIGN Retrospective cohort study using administrative data. SETTING Alberta, Canada between 2007 and 2016. PARTICIPANTS 47 169 adults deceased from: (1) cancer, (2) heart disease, (3) dementia, (4) stroke, (5) chronic lower respiratory disease (chronic obstructive pulmonary disease (COPD)), (6) liver disease, (7) neurodegenerative disease and (8) renovascular disease. MAIN OUTCOME MEASURES The proportion of decedents who experienced high hospital-based acute care in the last 30 days of life, indicated by ≥two emergency department (ED) visit, ≥two hospital admissions,≥14 days of hospitalisation, any intensive care unit (ICU) admission, or death in hospital. Relative risk (RR) and risk difference (RD) of hospital-based acute care given early specialist PC exposure (≥90 days before death), adjusted for patient characteristics. RESULTS In an analysis of all decedents, early specialist PC exposure was associated with a 32% reduction in risk of any hospital-based acute care as compared with those with no PC exposure (RR 0.69, 95% CI 0.66 to 0.71; RD 0.16, 95% CI 0.15 to 0.17). The association was strongest in cancer-specific analyses (RR 0.53, 95% CI 0.50 to 0.55; RD 0.31, 95% CI 0.29 to 0.33) and renal disease-specific analyses (RR 0.60, 95% CI 0.43 to 0.84; RD 0.22, 95% CI 0.11 to 0.34), but a~25% risk reduction was observed for each of heart disease, COPD, neurodegenerative diseases and stroke. Early specialist PC exposure was associated with reducing risk of four out of five individual indicators of high hospital-based acute care in the last 30 days of life, including ≥two ED visit,≥two hospital admission, any ICU admission and death in hospital. CONCLUSIONS Early specialist PC exposure reduced the risk of hospital-based acute care in the last 30 days of life for all chronic disease groups except dementia.
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Affiliation(s)
- Madalene Earp
- Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pin Cai
- Clinical Workforce Planning, Alberta Health Services, Calgary, Alberta, Canada
| | - Andrew Fong
- Data & Analytics, Alberta Health Services, Calgary, Alberta, Canada
| | - Kelly Blacklaws
- Data & Analytics, Alberta Health Services, Calgary, Alberta, Canada
| | - Truong-Minh Pham
- Surveillance and Reporting, Cancer Research and Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Lorraine Shack
- Surveillance and Reporting, Cancer Research and Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Aynharan Sinnarajah
- Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Palliative & End of Life Care Program, Calgary Zone, Alberta Health Services, Calgary, Alberta, Canada
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26
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Notsu M, Naito T, Mori K, Notsu A, Morikawa A, Kawabata T, Okayama T, Yonenaga Y, Sugiyama M, Kenmotsu H, Murakami H, Ito T, Kai M, Takahashi T. Days Spent at Home near the End of Life in Japanese Elderly Patients with Lung Cancer: Post hoc Analysis of A Prospective Study. Asia Pac J Oncol Nurs 2021; 8:228-236. [PMID: 33850956 PMCID: PMC8030590 DOI: 10.4103/2347-5625.311131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/22/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Days spent at home (DASH) near the end of life is considered an important patient-centered goal and outcome because many patients want to stay at home toward the end of life. This study aimed to estimate the individual DASH near the end of life and identify its early predictors, including muscle mass and physical function, among elderly patients with advanced non-small-cell lung cancer (NSCLC). Methods: We conducted a post hoc analysis of the prospective observational study (UMIN000009768) that recruited patients aged ≥ 70 years who were scheduled to undergo first-line chemotherapy because of advanced NSCLC. We measured the muscle mass by bioelectrical impedance analysis at baseline. DASH was calculated as 30 days minus the number of days spent in hospitals, palliative care facilities, or nursing homes during the last 30 days of life. We performed linear regression analyses to evaluate the predictors of DASH. Results: Altogether, 16 women and 28 men with a median overall survival of 15.5 months (range: 2.9–58.9) were included. The median DASH in the last 30 days of life was 8 days (range: 0–30, interquartile range: 0–23). Men had longer DASH than women by 7.3 days. Patients who had good trunk muscle mass index and hand-grip strength had significantly longer DASH than those who did not (4.7 days per kg/m2 increase [P = 0.017] and 0.4 days per kg increase [P = 0.032], respectively). Conclusions: Most elderly patients with advanced NSCLC had a limited DASH near the end of life. The risk factors for reduced DASH were women, reduced muscle mass, and poor physical function at the time of diagnosis of advanced NSCLC. Our findings would encourage early discussions about end-of-life care for patients with advanced cancers with risk factors for short DASH at the time of diagnosis, and thus, improve the quality of end-of-life care.
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Affiliation(s)
- Mikako Notsu
- Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan.,Graduate School, Oita University of Nursing and Health Sciences, Oita, Japan
| | - Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Keita Mori
- Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akifumi Notsu
- Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Ayumu Morikawa
- Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Taro Okayama
- Division of Rehabilitation Medicine, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yusuke Yonenaga
- Division of Rehabilitation Medicine, Shizuoka Cancer Center, Shizuoka, Japan
| | - Miwa Sugiyama
- Division of Nursing, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Haruyasu Murakami
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tomoko Ito
- Tachikawa Faculty of Nursing, Tokyo Healthcare University, Tokyo, Japan
| | - Michiaki Kai
- Department of Environmental Health Science, Oita University of Nursing and Health Sciences, Oita, Japan
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Ernst E, Schroeder C, Glover AC, Vesel T. Exploratory Study Comparing End-of-Life Care Intensity between Chinese American and White Advanced Cancer Patients at an American Tertiary Medical Center. Palliat Med Rep 2021; 2:54-58. [PMID: 34223504 PMCID: PMC8241368 DOI: 10.1089/pmr.2020.0064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Understanding ethnic disparities in end-of-life care (EOLC) intensity is central to improving outcomes for diverse populations. Although Chinese Americans represent one of the fastest growing ethnic groups in the United States, little is known about their EOLC intensity. Objective: To explore differences in indicators of high-intensity EOLC in the final 30 days of life, place of death, and hospice utilization between Chinese American and White advanced cancer patients. Methods: In this exploratory review, we collected data on 48 Chinese American and 48 White stage IV solid tumor patients who died during 2013–2018. Indicators of high-intensity care from the final 30 days of life included ≥2 hospital, ≥1 intensive care unit (ICU), and/or ≥2 emergency department admissions; cardiopulmonary resuscitation administration and mechanical ventilation (MV); place of death; and whether patients were on hospice at death. Results: Among Chinese American and White patients, respectively, 49% and 36% died in the hospital, 15% and 7% died in the ICU, 17% and 8% received MV, and 6% and 13% had ≥1 hospital admission lasting >14 days. Seventeen percent of Chinese American and 43% of White patients died at home. Hospice enrollment was similar between groups. Seventeen percent of Chinese American and 8% of White patients died within 30 days of diagnosis. Conclusion: Results suggest that fewer Chinese Americans died at home, whereas more died in the ICU, received MV, and died within 30 days of cancer diagnosis, indicating possible disparities in EOLC. Further studies are needed to explore findings from this exploratory investigation.
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Affiliation(s)
- Emma Ernst
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Courtney Schroeder
- Division of Hematology/Oncology, Department of Medicine, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Tamara Vesel
- Division of Palliative Care, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
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28
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Lam TC, Chan SK, Choi CW, Tsang KC, Yuen KK, Soong I, Wong KH, Lui L, Lo SH, Tong M, Lo RSK, Lam PT, Lam WM, Li B. Integrative Palliative Care Service Model Improved End-of-Life Care and Overall Survival of Advanced Cancer Patients in Hong Kong: A Review of Ten-Year Territory-Wide Cohort. J Palliat Med 2021; 24:1314-1320. [PMID: 33507834 DOI: 10.1089/jpm.2020.0640] [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: 12/25/2022] Open
Abstract
Background: Integrated palliative care in oncology service has been widely implemented in Hong Kong since 2006. Aim: The study aimed to review its impact on end-of-life outcomes and overall survival (OS) of cancer patients, as well as its utilization of health care resources in the past 10 years. Design: Cancer deaths of all 43 public hospitals of Hong Kong were screened. Setting/Participants: Randomly selected 2800 cancer deaths formed a representative cohort in all seven service clusters of Hospital Authority at four time points (2006, 2009, 2012, and 2015). Individual patient records were thoroughly reviewed. Propensity score-matched (PSM) analysis was employed to compare the survival of patients. Results: Palliative care provision was associated with improved palliative care outcome, including more prescription of strong opioid, fewer cardiopulmonary resuscitations and intensive care unit admissions, and less futile chemotherapy usage in the end-of-life period (all p < 0.001). In the PSM analysis, the median OS in patients with palliative service (5.10 months, 95% confidence interval [CI] 4.52-5.68 months) was significantly better than those without palliative service (1.96 months, 95% CI 1.66-2.27 months). Patients in the palliative care group had more specialist clinic visits (p < 0.001) and longer hospital stay (p < 0.001) in the last six months of life, although the duration of last admission stay at acute general ward was shortened (p < 0.001). Conclusion: Our results suggested palliative care has played a role in the remarkable improvement in end-of-life outcomes and OS. However, current palliative care model relied heavily on hospital resources. Future work is needed to strengthen community care and to build up quality monitoring systems.
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Affiliation(s)
- Tai-Chung Lam
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Sik-Kwan Chan
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Cheuk-Wai Choi
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ka-Chun Tsang
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kwok-Keung Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
| | - Inda Soong
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Kam-Hung Wong
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China
| | - Louisa Lui
- Department of Clinical Oncology, Princess Margaret Hospital, Hong Kong, China
| | - Sing-Hung Lo
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Macy Tong
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, China
| | - Raymond S K Lo
- Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong, China.,Bradbury Hospice, Hong Kong, China
| | - Po-Tin Lam
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China
| | - Wai-Man Lam
- Pulmonary and Palliative Care Unit, Haven of Hope Hospital, Hong Kong, China
| | - Bryan Li
- Palliative Medicine Unit, Grantham Hospital, Hong Kong, China
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29
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Martí-García C, Fernández-Alcántara M, Suárez López P, Romero Ruiz C, Muñoz Martín R, Garcia-Caro MP. Experiences of family caregivers of patients with terminal disease and the quality of end-of-life care received: a mixed methods study. PeerJ 2020; 8:e10516. [PMID: 33362972 PMCID: PMC7745673 DOI: 10.7717/peerj.10516] [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: 06/15/2020] [Accepted: 11/17/2020] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to analyze the perceptions and experiences of relatives of patients dying from a terminal disease with regard to the care they received during the dying process, considering the oncological or non-oncological nature of the terminal disease, and the place where care was provided (at home, emergency department, hospital room, or palliative care unit). For this purpose, we conducted a mixed-methods observational study in which two studies were triangulated, one qualitative using semi-structured interviews (n = 30) and the other quantitative, using questionnaires (n = 129). The results showed that the perception of relatives on the quality of care was highly positive in the quantitative evaluation but more critical and negative in the qualitative interview. Experience of the support received and palliative measures was more positive for patients attended in hospital in the case of oncological patients but more positive for those attended at home in the case of non-oncological patients.
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Affiliation(s)
- Celia Martí-García
- Department of Nursing, University of Málaga, Málaga, Spain
- Mind, Brain and Behaviour Research Center (CIMCYC), University of Granada, Granada, Spain
| | | | | | | | - Rocío Muñoz Martín
- Distrito sanitario Granada-Metropolitano de Atención Primaria, Granada, Spain
| | - Mᵃ Paz Garcia-Caro
- Mind, Brain and Behaviour Research Center (CIMCYC), University of Granada, Granada, Spain
- Department of Nursing, University of Granada, Granada, Spain
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30
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Telles JPM, Yamaki VN, Yamashita RG, Solla DJF, Paiva WS, Teixeira MJ, Neville IS. The impact of urgent neurosurgery on the survival of cancer patients. Surg Neurol Int 2020; 11:258. [PMID: 33024596 PMCID: PMC7533081 DOI: 10.25259/sni_476_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/05/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Patients with cancer are subject to all neurosurgical procedures of the general population, even if they are not directly caused by the tumor or its metastases. We sought to evaluate the impact of urgent neurosurgery on the survival of patients with cancer. Methods: We included patients submitted to neurosurgeries not directly related to their tumors in a cancer center from 2009 to 2018. Primary endpoints were mortality in index hospitalization and overall survival. Results: We included 410 patients, 144 went through elective procedures, functional (26.4%) and debridement (73.6%) and 276 urgent neurosurgeries were performed: one hundred and sixty-three ventricular shunts (59%), and 113 intracranial hemorrhages (41%). Median age was 56 (IQR = 24), 142 (51.4%) of patients were metastatic, with 101 (36.6%) having brain metastasis. In 82 (33.7%) of the urgent surgeries, the patient died in the same admission. Urgent surgeries were associated with mortality in index hospitalization (OR 3.45, 95% CI 1.93–6.15), as well as non-primary brain tumors (OR 3.13, 95% CI 1.48–6.61). Median survival after urgent surgeries was 102 days, compared to 245 days in the control group (Log rank, P < 0.01). Lower survival probability was associated with metastasis (HR 1.75, 95%CI 1.15–2.66) and urgent surgeries (HR 1.49, 95% CI 1.18–1.89). Within the urgent surgeries alone, metastasis predicted lower survival probability (HR 1.75, 95% CI 1.15–2.67). Conclusion: Conditions that require urgent neurosurgery in patients with cancer have a very poor prognosis. We present concrete data on the magnitude of several factors that need to be taken into account when deciding whether or not to recommend surgery.
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Affiliation(s)
- Joao Paulo Mota Telles
- Department of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Vitor Nagai Yamaki
- Department of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Renata Gobbato Yamashita
- Department of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Davi Jorge Fontoura Solla
- Department of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | | | | | - Iuri Santana Neville
- Department of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
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31
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Elchoufi D, Duszak R, Balthazar P, Hanna TN, Sadigh G. Increasing emergency department utilization of brain imaging in patients with primary brain cancer. Emerg Radiol 2020; 28:223-231. [PMID: 32803458 DOI: 10.1007/s10140-020-01836-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/03/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To study changing emergency department (ED) brain imaging utilization in patients with primary brain cancers. METHODS Using 2006-2014 data from the Nationwide Emergency Department Sample (NEDS), we identified all patients with primary brain cancers visiting EDs and evaluated trends of head CT and brain MRI utilization. Multivariable logistic regression analyses were used to determine patient- and hospital-specific factors associated with brain imaging utilization. RESULTS A weighted cohort of 40,862 ED visits were included (mean age 55; 54% male), increasing from 3932 in 2006 to 5625 in 2014 (+ 43%). A total of 14.4% underwent brain imaging, with 13.2% undergoing CT, 2.3% undergoing MRI, and 1.1% undergoing both modalities. Between 2006 and 2014, there was a 104% increase in the rate of ED brain imaging (from 9.7% in 2006 to 19.8% in 2014). Factors associated with higher utilization of ED brain imaging in adults were non-teaching hospital status and Midwest and Northeast hospital regions (compared with the West). In pediatric patients, higher utilization was associated with older age, higher median household income of patient's ZIP code, and visits in rural, non-teaching hospitals located in the Midwest, South, and Northeast (compared with the West). CONCLUSION In US patients with primary brain cancer, the number of ED visits increased annually, and the utilization of ED head imaging examinations doubled in a recent 9-year period. A variety of sociodemographic characteristics are associated with a higher likelihood of imaging in both adult and pediatric patients.
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Affiliation(s)
- Deema Elchoufi
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, Suite BG27, Atlanta, GA, 30322, USA
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, Suite BG27, Atlanta, GA, 30322, USA
| | - Patricia Balthazar
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, Suite BG27, Atlanta, GA, 30322, USA
| | - Tarek N Hanna
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, Suite BG27, Atlanta, GA, 30322, USA
| | - Gelareh Sadigh
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, Suite BG27, Atlanta, GA, 30322, USA.
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Abstract
BACKGROUND AND OBJECTIVES The use of chemotherapy at the end of life in advanced cancer patients has increased and end of life care has become increasingly aggressive. The aim of this study is to evaluate patients receiving chemotherapy in the last 3 months of life and the aggressiveness of end-of-life support of these patients. METHODS All adult patients with solid tumors who received chemotherapy in their last 3 months of life and died in our hospital between January 2015 to June 2019 were included. Detailed information on chemotherapy and toxicity was collected in patient records. RESULTS A total of 182 patients included. Median age was 58,9 years. The median survival from the docementation of metastatic disease was 9,98 months (0,95-64,3). Of these 182 patients, 95 (52%) were treated with chemotherapy in the last month of life and 52 (29%) in the last 2 weeks of life. The median number of days between the last administration of chemotherapy and patient death was 29 (0-90). A new chemotherapy regimen was started in the last 3 months of life in 102 patients (56%), in the last month of life in 43 patients (23,6%) and in the last 2 weeks in 23 patients (12.6%). DISCUSSION AND IMPLICATIONS There are many patients who received chemotherapy in the last 3 months of their life and the rates of chemotherapy initiation during this period are well above ideal rates. Whether such care has positive effects on survival or quality of life is questionable and deserves additional investigation.
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Affiliation(s)
- Semiha Urvay
- Radiotherapy, Acibadem University Vocational School of Health Services, Istanbul, Turkey
| | - Burak Civelek
- Medical Oncology, Acibadem Kayseri Hospital, Kayseri, Turkey
| | - Ersin Özaslan
- Medical Oncology, Acibadem Kayseri Hospital, Kayseri, Turkey
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33
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Look Hong NJ, Liu N, Wright FC, MacKinnon M, Seung SJ, Earle CC, Gradin S, Sati S, Buchman S, Mittmann N. Assessing the Impact of Early Identification of Patients Appropriate for Palliative Care on Resource Use and Costs in the Final Month of Life. JCO Oncol Pract 2020; 16:e688-e702. [DOI: 10.1200/jop.19.00397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE:This study evaluates whether an intervention to identify Canadian patients eligible for a palliative approach changes the use of health care resources and costs within the final month of life.METHODS:Between 2014 and 2017, physicians identified 1,187 patients in family practice units and cancer centers who were likely to die within 1 year based on diagnosis, symptom assessment, and performance status. A multidisciplinary intervention that included activation of community resources and initiation of palliative planning was started. By using propensity-score matching, patients in the intervention group were matched 1:1 with nonintervention controls selected from provincial administrative data. We compared health care use and costs (using 2017 Canadian dollars) for 30 days before death between patients who died within the 1-year follow-up and matched controls.RESULTS:Groups (n = 629 in each group) were well-balanced in sociodemographic characteristics, comorbidities, and previous health care use. In the last 30 days, there was no differences in proportions between the two groups of patients regarding emergency department visits, intensive care unit admissions, or inpatient hospitalizations. However, patients in the intervention group had greater use of palliative physician encounters, community home care visits, and/or physician home visits (92.8% v 88.4%; P = .007). In the 507 pairs with cancer, more patients in the intervention group underwent chemotherapy (44% v 33%; P < .001) and radiation (18.7% v 3.2%; P = .043) in the last 30 days. Mean cost per patient was similar for the intervention group (mean, $17,231; 95% CI, $16,027 to $18,436) and for the control group (mean, $16,951; 95% CI, $15,899 to $18,004).CONCLUSION:Even with the limitations in our observational study design, identification of palliative patients did not significantly change overall costs but may shift resources toward palliative services.
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Affiliation(s)
- Nicole J. Look Hong
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ning Liu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Frances C. Wright
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Soo Jin Seung
- Health Outcomes and PharmacoEconomic Research Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Craig C. Earle
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Sharon Gradin
- British Columbia Renal Agency, Toronto, Ontario, Canada
| | | | | | - Nicole Mittmann
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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34
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Cerni J, Rhee J, Hosseinzadeh H. End-of-Life Cancer Care Resource Utilisation in Rural Versus Urban Settings: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144955. [PMID: 32660146 PMCID: PMC7400508 DOI: 10.3390/ijerph17144955] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/30/2020] [Accepted: 07/03/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Despite the advances in End-of-life (EOL) cancer care, disparities remain in the accessibility and utilisation of EOL cancer care resources. Often explained by socio-demographic factors, geographic variation exists in the availability and provision of EOL cancer care services among EOL cancer decedents across urban versus rural settings. This systematic review aims to synthesise mortality follow-back studies on the patterns of EOL cancer care resource use for adults (>18 years) during end-of-life cancer care. METHODS Five databases were searched and data analysed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria involved; a) original research; b) quantitative studies; c) English language; d) palliative care related service use in adults (>18 years) with any malignancy excluding non-melanoma skin cancers; e) exclusive end of life focus; f) urban-rural focus. Narrative reviews and discussions were excluded. RESULTS 24 studies met the inclusion criteria. End-of-life cancer care service utilisation patterns varied by rurality and treatment intent. Rurality was strongly associated with higher rates of Emergency Department (ED) visits and hospitalisations and lower rates of hospice care. The largest inequities between urban and rural health service utilisation patterns were explained by individual level factors including age, gender, proximity to service and survival time from cancer diagnosis. CONCLUSIONS Rurality is an important predictor for poorer outcomes in end-of-life cancer care. Findings suggest that addressing the disparities in the urban-rural continuum is critical for efficient and equitable palliative cancer care. Further research is needed to understand barriers to service access and usage to achieve optimal EOL care for all cancer patient populations.
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Affiliation(s)
- Jessica Cerni
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia;
- Correspondence:
| | - Joel Rhee
- General Practice Academic Unit, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522, Australia;
- Illawarra Southern Practice Based Research Network (ISPRN), University of Wollongong, Wollongong, NSW 2522, Australia
- Centre for Positive Ageing + Care, HammondCare, Hammondville, NSW 2170, Australia
| | - Hassan Hosseinzadeh
- School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia;
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Chiang JK, Kao YH. Effect of hospice care on health-care costs for Taiwanese patients with cancer during their last month of life in 2004-2011: A trend analysis. Tzu Chi Med J 2020; 32:278-285. [PMID: 32955513 PMCID: PMC7485665 DOI: 10.4103/tcmj.tcmj_90_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/19/2019] [Accepted: 06/19/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE End-of-life cancer care imposes a heavy financial burden on patients, their families, and their health insurers. The aim of this study was to explore the 8-year (2004-2011) trends in health-care costs for Taiwanese cancer decedents in their last month of life and, specifically, to assess the association of these trends with hospice care. MATERIALS AND METHODS We conducted a population-based longitudinal study and analyzed data from Taiwan's National Health Insurance Research Database. The data consisted of not only claims information - costs of hospitalization and outpatient department visits - but also the associated patient characteristics, catastrophic illness status, hospice patient designation, and insurance system exit date (the proxy for death). RESULTS A total of 11,104 cancer decedents were enrolled, and 2144 (19.3%) of these patients received hospice care. The rate of hospice service use increased from 14.9% to 21.5% over 8 years. From 2004 to 2011, the mean health-care cost per day in the last month of life increased 8.2% (from US$93 ± $108 in 2004 to US$101 ± $110 in 2011; P = 0001). We compared three groups of patients who received hospice care for more than 1 month (long-H group), received hospice care for 30 days or less (short-H group), and did not receive hospice care (non-H group). Compared to non-H group, long-H group had a significantly lower mean health-care cost per day during their last month of life (US$85.7 ± 57.3 vs. US$102.4 ± 120) (P < 0001). Furthermore, compared to short-H and non-H groups, patients in the long-H group had lower probabilities of receiving chemotherapy and visiting the emergency department more than once. They also incurred lower health-care costs (US$77.1 ± 58.1 vs. US$92.2 ± 56.0 for short-H group and US$102.4 ± 120 for non-H group) (P < 0001). CONCLUSION Health-care costs in the last month of life are increasing over time in Taiwan. Nonetheless, health-care costs for patients receiving hospice can be as much as 16.3% lower than patients not receiving hospice care. Patients receiving hospice care for more than 30 days also had lower health-care costs than those receiving care for <30 days.
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Affiliation(s)
- Jui-Kun Chiang
- Department of Family Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Yee-Hsin Kao
- Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan
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Chen B, Kanaan C, Jaiyesimi I, Ezekwudo D, Swor R. Clinical Characteristics of Patients with Cancer Presenting to the Emergency Department and Their Use of Emergency Medical Service Transport. PREHOSP EMERG CARE 2020; 24:813-821. [PMID: 31961753 DOI: 10.1080/10903127.2020.1718258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Although life-threatening emergencies for cancer patients are relatively rare, cancer patients often seek care in the emergency department. The use of emergency medical service (EMS) by these patients is not well studied. The aim of this study was to investigate the characteristics of cancer patients who present to the emergency department (ED) for care and compare characteristics of patients transported by EMS vs. those transported by private vehicle. Methods: Our retrospective cohort study was conducted in an EMS system with 21,070 annual transports and an academic ED with 129,263 annual visits. Our study consisted of patients with a new diagnosis of cancer between January 1 and July 1, 2015 who subsequently presented to the ED between January 1, 2015 and July 1, 2017. Study variables included patient demographics, mode of ED arrival, cancer type and treatment, patient clinical characteristics, and disposition. To describe differences in patient characteristics of EMS vs. private vehicle transport, we report variable frequencies and stratified them by mode of transport. Results: Of the 2,727 patients with a new diagnosis of cancer, 1,303 (47.8%) presented to the ED with a total of 3,590 visits in 30 months. EMS transported 22% of cancer patients to the ED vs. 78% transported by private vehicle. Thus, cancer patients would make up approximately 1.5% (781/52,675) of all EMS transports during the study period. For those transported by EMS, the most common chief complaints were respiratory distress (16.0%), pain (15.4%), and neurological symptoms (12.6%). Patients with cancer of the lung/respiratory tract (21.5%), upper GI (12.4%), and central nervous system (CNS) (11.0%) were most frequently transported by EMS. Older age, presence of CNS cancer, presentation with neurological or cardiovascular complaints, and higher acuity were significantly associated with EMS transport to ED, while gender and pain severity were not. Patients transported by EMS were more likely to be hospitalized and for greater than 2 days (p < 0.0001). Conclusions: Cancer patients frequently seek emergency care after initial diagnosis, most commonly present for symptom relief, and are often admitted. Patients transported by EMS are more likely to be admitted and for longer periods of time.
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Phillips CM, Deal K, Powis M, Singh S, Dharmakulaseelan L, Naik H, Dobriyal A, Alavi N, Krzyzanowska MK. Evaluating Patients' Perception of the Risk of Acute Care Visits During Systemic Therapy for Cancer. JCO Oncol Pract 2020; 16:e622-e629. [PMID: 32074009 DOI: 10.1200/jop.19.00551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Unplanned emergency department (ED) visits and hospitalizations are common during systemic cancer therapy. To determine how patients with cancer trade off treatment benefit with risk of experiencing an ED visit or hospitalization when deciding about systemic therapy, we undertook a discrete choice experiment. MATERIALS AND METHODS Patients with breast, colorectal, or head and neck cancer contemplating, receiving, or having previously received systemic therapy were presented with 10 choice tasks (5 in the curative and 5 in the palliative setting) that varied on 3 attributes: benefit, risk of ED visit, and risk of hospitalization. Preferences for attributes and levels were measured using part-worth utilities, estimated using hierarchical Bayes analysis. Segmentation analysis was conducted to identify subgroups with different preferences. RESULTS A total of 293 patients completed the survey; most were female (76%), had breast cancer (63%), and were currently receiving systemic therapy (72%) with curative intent (59%). Benefit was the most important decision attribute regardless of treatment intent, followed by risk of hospitalization, then risk of ED visit. Two segments were observed: one large cluster exhibiting logical and consistent choices, and a smaller segment exhibiting illogical and inconsistent choices. Patients in the latter segment were more likely to have metastatic head and neck cancer, be male, were older, and reported fewer prior ED visits. CONCLUSION Although the risk of ED visit or hospitalization contributes to patient treatment preferences, benefit was the most important attribute. Segmentation suggests that a subset of patients may lack cognitive abilities, engagement, or literacy to consistently evaluate treatment choices. Understanding this subset may provide insight into patients' decision making and understanding of treatment options.
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Affiliation(s)
- Cameron M Phillips
- University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ken Deal
- McMaster University, Hamilton, Ontario, Canada
| | - Melanie Powis
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Simron Singh
- University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Harsh Naik
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Aditi Dobriyal
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Nasrin Alavi
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Rae CS, Pole JD, Gupta S, Digout C, Szwajcer D, Flanders A, Srikanthan A, Hammond C, Schacter B, Barr RD, Rogers PC. Development of System Performance Indicators for Adolescent and Young Adult Cancer Care and Control in Canada. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:74-88. [PMID: 31952676 DOI: 10.1016/j.jval.2019.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 08/01/2019] [Accepted: 08/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To develop an expert-group, consensus-based list of system performance indicators to be used for monitoring, evaluating, and benchmarking progress for cancer care and control in adolescents and young adults (AYAs) in Canada. METHODS A national multidisciplinary panel of AYA oncology experts was convened; they prepared a literature review and undertook a brainstorming exercise to create a comprehensive list of indicators based on a previously defined framework for AYA cancer care and control in Canada. A modified Delphi process was then undertaken to cull the list based on 3 quick screen criteria. Three rounds of ranking were required. The fourth stage employed a face-to-face meeting, and the final stage utilized a survey to rank the indicators on the basis of importance and feasibility. RESULTS Nineteen participants contributed to the 5-stage process. From an initial list of 114 indicators, 14 were ultimately endorsed, representing 5 themes: active care, survivorship, psychosocial issues, palliative care, and research. The 5 highest ranked indicators were assessed as very to moderately feasible, with only a single indicator (clinical trial enrollment) in the top 5 assigned a least feasible ranking. CONCLUSION The 14 indicators provide a starting point for the development of a standard set of metrics for AYA cancer care and control in Canada and have potential for international utility.
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Affiliation(s)
- Charlene S Rae
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Jason D Pole
- Pediatric Oncology Group of Ontario and Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Sumit Gupta
- Division of Hematology/Oncology, Hospital for Sick Children and Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carol Digout
- Atlantic Provinces Pediatric Hematology Oncology Network, IWK Health Centre, Halifax, NS, Canada
| | | | | | - Amirrtha Srikanthan
- Department of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Chad Hammond
- Canadian Hospice Palliative Care Association and School of Rehabilitation, University of Ottawa, Ottawa, ON, Canada
| | | | - Ronald D Barr
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
| | - Paul C Rogers
- Division of Hematology/Oncology/BMT, BC Children's Hospital, Vancouver, BC, Canada
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Guthrie DM, Harman LE, Barbera L, Burge F, Lawson B, McGrail K, Sutradhar R, Seow H. Quality Indicator Rates for Seriously Ill Home Care Clients: Analysis of Resident Assessment Instrument for Home Care Data in Six Canadian Provinces. J Palliat Med 2019; 22:1346-1356. [DOI: 10.1089/jpm.2019.0022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dawn M. Guthrie
- Department of Kinesiology and Physical Education and Wilfrid Laurier University, Waterloo, Ontario, Canada
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Lisa E. Harman
- Department of Kinesiology and Physical Education and Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Lisa Barbera
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kimberlyn McGrail
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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Chiang JK, Lee YC, Kao YH. Association between palliative care and end-of-Life care for patients with hematological malignancies: A population-based study. Medicine (Baltimore) 2019; 98:e17395. [PMID: 31577748 PMCID: PMC6783235 DOI: 10.1097/md.0000000000017395] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
To date, few studies have examined the end-of-life (EOL) care for patients with hematological malignancies (HMs). We evaluated the effects of palliative care on the quality of EOL care and health care costs for adult patients with HMs in the final month of life.We conducted a population-based study and analyzed data from Taiwan's Longitudinal Health Insurance Database, which contains claims information for patient medical records, health care costs, and insurance system exit dates (our proxy for death) between 2000 and 2011.A total of 724 adult patients who died of HMs were investigated. Of these patients, 43 (5.9%) had received only inpatient palliative care (i-Pal group), and 19 (2.6%) received home palliative care (h-Pal group). The mean health care costs during the final month of life were not significantly different between the non-Pal and Pal groups (p=0.315) and between the non-Pal, i-Pal, and h-Pal groups (p=0.293) either. By the multivariate regression model, the i-Pal group had lower risks of chemotherapy, ICU admission, and receipt of CPR, but higher risks of at least two hospitalizations and dying in hospital after adjustments. The h-Pal group had the similar trends as the i-Pal group but lower risk of dying in hospital after adjustments.Patients with HMs who had received palliative care could benefit from less aggressive EOL cancer care in the final month of life. However, 8.6% patients with HMs received palliative care. The related factors of more hospitalizations and dying in hospital warrant further investigation.
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Affiliation(s)
- Jui-Kun Chiang
- Department of Family Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
| | | | - Yee-Hsin Kao
- Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan
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41
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Cheung MC, Croxford R, Earle CC, Singh S. Days spent at home in the last 6 months of life: a quality indicator of end of life care in patients with hematologic malignancies. Leuk Lymphoma 2019; 61:146-155. [DOI: 10.1080/10428194.2019.1654095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Matthew C. Cheung
- Division of Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | | | - Craig C. Earle
- Division of Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- ICES, Toronto, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Simron Singh
- Division of Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
- ICES, Toronto, Canada
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Baena-Cañada JM, Campini Bermejo A, Gámez Casado S, Rodríguez Pérez L, Quílez Cutillas A, Calvete Candenas J, Martínez Bautista MJ, Benítez Rodríguez E. Experiences with Prescribing Large Quantities of Systemic Anticancer Therapy Near Death. J Palliat Med 2019; 22:1515-1521. [PMID: 31184989 DOI: 10.1089/jpm.2019.0017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The most important decision after diagnosing terminal cancer is whether to provide active therapy or withhold treatment. Objective: To analyze the aggressiveness of care by evaluating systemic anticancer therapy (SACT) given near to death, describing this care and identifying factors that determine its use. Design: This involves retrospective observational cohorts study. Setting/Subjects: This involves patients with metastatic tumors who died at a University Hospital in Spain between 2015 and 2016. Measurements: Data obtained from prescribing oncologists and patients' clinical records, type of cancer, and information on treatment. The dependent variable used was the interval between the date of the last dose and date of death. Results: Ninety-four (32.60%) of 288 patients received SACT in the last month of life. This cohort had a higher frequency of lung cancer (OR: 1.58; CI 95%: 1.14-2.18), received more care from oncologist 2 (OR: 1.50; CI 95%: 1.08-2.08), had fewer last-line treatment cycles (OR: 1.28; CI 95%: 1.13-1.45), a lower subjective response (OR: 3.13; CI 95%: 1.34-7.29), less clinical benefit (OR: 2.38; CI 95%: 1.04-5.55), more visits to the Emergency Department (OR: 1.59; CI 95%: 1.06-2.38), and less care from the Palliative Care Unit (OR: 4.55; CI 95%: 2.69-7.70). In multivariate analysis, the predictors of having received SACT close to death remained: receiving fewer cycles of treatment (OR: 1.28; CI 95%: 1.12-1.47) and less palliative care (OR: 4.54; CI 95%: 2.56-7.69). Conclusions: A third of cancer patients received SACT in the last month of life with less efficacy and poorer quality of care than patients not receiving it.
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Affiliation(s)
- José M Baena-Cañada
- Medical Oncology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
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Sivendran S, Lynch S, McNaughton C, Wong R, Svetec S, Moore JH, Holliday R, Oyer RA, Newport K. Anticancer Therapy at the End of Life: Lessons From a Community Cancer Institute. J Palliat Care 2019; 36:87-92. [PMID: 31187695 DOI: 10.1177/0825859719851484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Studies have shown aggressive cancer care at the end of life is associated with decreased quality of life, decreased median survival, and increased cost of care. This study describes the patients most likely to receive systemic anticancer therapy at the end of life in a community cancer institute. MATERIALS AND METHODS We performed a retrospective cohort study of 201 patients who received systemic anticancer therapy in our institution and died between July 2016 and April 2017. Data collected included primary malignancy, hospice enrollment, healthcare utilization, Oncology Care Model (OCM) enrollment, and clinical assessments at last office visit prior to a treatment decision before death. We defined our outcome variable as the receipt of anticancer treatment in the last 14 days of a patient's life. We evaluated 20 clinical exposure variables with respect to the outcome classes. Risk ratios along with their associated confidence intervals and P values were calculated. Significance was determined using the Benjamini-Hochberg procedure to account for multiple testing. RESULTS Of the 201 patients who died of cancer, 36 (17%) received anticancer therapy within the last 14 days of life. Several risk factors were significantly positively associated with receiving anticancer therapy at the end of life including hospitalization within 30 days of end of life, number of hospitalizations per patient (≥2), death in hospital, enrollment in OCM, and a diagnosis of hematologic malignancy. CONCLUSION Our findings demonstrate those enrolled in the OCM and those with hematologic malignancies have a higher risk of receiving anticancer therapy in the last 14 days of life. These observations highlight the need for better identifying the needs of high-risk patients and providing good quality care throughout the disease trajectory to better align end-of-life care with patients' wishes.
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Affiliation(s)
- Shanthi Sivendran
- Ann B. Barshinger Cancer Institute, 328946PENN Medicine at Lancaster General Health, Lancaster, PA, USA
| | - Selah Lynch
- Institute for Biomedical Informatics, Perelman School of Medicine, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Caitlyn McNaughton
- Ann B. Barshinger Cancer Institute, 328946PENN Medicine at Lancaster General Health, Lancaster, PA, USA
| | - Riley Wong
- Institute for Biomedical Informatics, Perelman School of Medicine, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah Svetec
- Ann B. Barshinger Cancer Institute, 328946PENN Medicine at Lancaster General Health, Lancaster, PA, USA
| | - Jason H Moore
- Institute for Biomedical Informatics, Perelman School of Medicine, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Rachel Holliday
- Ann B. Barshinger Cancer Institute, 328946PENN Medicine at Lancaster General Health, Lancaster, PA, USA
| | - Randall A Oyer
- Ann B. Barshinger Cancer Institute, 328946PENN Medicine at Lancaster General Health, Lancaster, PA, USA
| | - Kristina Newport
- Section of Palliative Care, Pennsylvania State University College of Medicine, Hershey, PA, USA
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Abdel-Razeq H, Shamieh O, Abu-Nasser M, Nassar M, Samhouri Y, Abu-Qayas B, Asfour J, Jarrah J, Abdelrahman Z, Ameen Z, Al-Hawamdeh A, Alomari M, Al-Tabba' A, Al-Rimawi D, Hui D. Intensity of Cancer Care Near the End of Life at a Tertiary Care Cancer Center in Jordan. J Pain Symptom Manage 2019; 57:1106-1113. [PMID: 30802634 DOI: 10.1016/j.jpainsymman.2019.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/19/2019] [Accepted: 02/19/2019] [Indexed: 12/11/2022]
Abstract
CONTEXT Chemotherapy use in the last month of life is an indicator of poor quality of end-of-life care. OBJECTIVES We assessed the frequency of chemotherapy use at the end of life at our comprehensive cancer center in Jordan and identified the factors associated with chemotherapy use. METHODS We conducted a retrospective chart review to examine the use of chemotherapy in the last 30 days and 14 days of life in consecutive adult patients with cancer seen at King Hussein Cancer Center (KHCC) who died between January 1, 2010, and December 31, 2012. We collected data on patient and disease characteristics, palliative care referral, and end-of-life care outcome indicators. RESULTS Among the 1714 decedents, 310 (18.1%) had chemotherapy use in the last 30 days and 142 (8.3%) in the last 14 days of life. Over half (910; 53.1%) had a palliative care referral. Chemotherapy use in the last 30 and 14 days of life were associated with younger age (odds ratio [OR] 0.99/yr, P = 0.01, and OR 0.99/yr, P = 0.01, respectively) and hematological malignances (OR 1.98, P < 0.001, and OR 2.85, P < 0.001, respectively). Palliative care referral was significantly associated with decreased use of chemotherapy in the last 30 (OR 0.30, P < 0.001) and 14 (OR 0.15, P < 0.001) days of life. CONCLUSIONS A sizable minority of patients with cancer at KHCC received chemotherapy at the end of life. Younger patients and those with hematological malignancies were more likely to receive chemotherapy, whereas those referred to palliative care were significantly less likely to receive chemotherapy at the end of life.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Zaid Ameen
- King Hussein Cancer Center, Amman, Jordan
| | | | | | | | | | - David Hui
- MD Anderson Cancer Center, Houston, Texas, USA
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Evans JM, Mackinnon M, Pereira J, Earle CC, Gagnon B, Arthurs E, Gradin S, Buchman S, Wright FC. Integrating early palliative care into routine practice for patients with cancer: A mixed methods evaluation of the INTEGRATE Project. Psychooncology 2019; 28:1261-1268. [PMID: 30946500 DOI: 10.1002/pon.5076] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/27/2019] [Accepted: 04/01/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE With increasing evidence from controlled trials on benefits of early palliative care, there is a need for studies examining implementation in real-world settings. The INTEGRATE Project was a 3-year real-world project that promoted early identification and support of patients with cancer who may benefit from palliative care. This study assesses feasibility, stakeholder experiences, and early impact of the INTEGRATE Project METHODS: The INTEGRATE Project was implemented in four cancer centers in Ontario, Canada, and consisted of interdisciplinary provider education and an integrated care model. Providers used the Surprise Question to identify patients for inclusion. A mixed methods evaluation of INTEGRATE was conducted using descriptive data, interviews with providers and managers, and provider surveys. RESULTS A total of 760 patients with cancer (lung, glioblastoma, head and neck, gastrointestinal) were included. Results suggest improvement in provider confidence to deliver palliative care and to initiate the Advanced Care Planning (ACP) conversation. The majority of patients (85%) had an ACP or goals of care (GOC) conversation initiated within a mean time to conversation of 5-46 days (SD 20-93) across centers. A primary care report was transmitted to family doctors 48-100% of the time within a mean time to transmission of 7-54 days (SD 9-27) across centers. Enablers and barriers influencing success of the model were also identified. CONCLUSIONS A standardized model for the early introduction of palliative care for patients with cancer can be integrated into the routine practice of oncology providers, with appropriate education, integration into existing clinical workflows, and administrative support.
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Affiliation(s)
- Jenna M Evans
- Integrated Care Unit, Cancer Care Ontario, Toronto.,DeGroote School of Business, McMaster University, Hamilton
| | | | - Jose Pereira
- Academic Family Medicine Division, College of Family Physicians of Canada, Mississauga.,School of Medicine, Faculty of Health Sciences, Queen's University, Kingston.,Division of Palliative Care, Department of Family Medicine, University of Ottawa, Ottawa.,Division of Palliative Care, Faculty of Health Sciences, McMaster University, Hamilton.,Pallium Canada, Ottawa
| | - Craig C Earle
- Institute for Clinical and Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto
| | - Bruno Gagnon
- Department of Family Medicine and Emergency Medicine, Cancer Research Centre, Laval University, Quebec City
| | - Erin Arthurs
- Integrated Care Unit, Cancer Care Ontario, Toronto
| | | | - Sandy Buchman
- The Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto.,Division of Palliative Care, Department of Family & Community Medicine, University of Toronto, Toronto
| | - Frances C Wright
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto
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Kyeremanteng K, Ismail A, Wan C, Thavorn K, D'Egidio G. Outcomes and Cost of Patients With Terminal Cancer Admitted to Acute Care in the Final 2 Weeks of Life: A Retrospective Chart Review. Am J Hosp Palliat Care 2019; 36:1020-1025. [PMID: 30991816 DOI: 10.1177/1049909119843285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients with terminal conditions are often admitted to the emergency department (ED) for acute medical services, but studies have suggested that multiple ED admissions may negatively impact end-of-life (EOL) care. Research have shown that incorporating palliative care (PC) is integral to optimal EOL care, but it is an aspect of medical practice that is often neglected. The current study sought to provide an overview of health outcomes and hospital costs of patients with cancer admitted to The Ottawa Hospital and/or received acute medical services during their final 2 weeks of life. Cost comparisons and estimates were made between hospital and hospice expenditures. METHODS We conducted a retrospective chart review of palliative patients who died at The Ottawa Hospital in 2012. A total of 130 patients who visited the ED within 2 weeks of death were included in the analyses. RESULTS In this cohort of patients, 71% of admitted patients did not have advanced care directives and 85% experienced a metastasis, but only 18% had a PC medical doctor. Patients were hospitalized, on average, for 7 days and hospitalization costs exceeded the estimated hospice cost by approximately 2.5 times (Can$1 041 170.00 at Can$8009.00/patient vs Can$401 570.00 at Can$3089.00/patient, respectively). CONCLUSION Our study highlighted the importance of PC integration in high-risk patients, such as those in oncology. Patients in our sample had minimal PC involvement, low advanced care directives, and accrued high costs. Based on our analyses, we concluded that these patients would have likely benefited more from hospice care rather than hospitalization.
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Affiliation(s)
- Kwadwo Kyeremanteng
- 1 Division of Critical Care, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,2 Division of Palliative Care, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,3 Institute du Savoir Montfort, Ottawa, Ontario, Canada.,4 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Abid Ismail
- 1 Division of Critical Care, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,5 The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Cynthia Wan
- 6 School of Psychology, Faculty of Social Sciences, University of Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- 5 The Ottawa Hospital, Ottawa, Ontario, Canada.,7 School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Gianni D'Egidio
- 1 Division of Critical Care, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,5 The Ottawa Hospital, Ottawa, Ontario, Canada
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47
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Lawson BJ, Burge FI, Mcintyre P, Field S, Maxwell D. Palliative Care Patients in the Emergency Department. J Palliat Care 2019. [DOI: 10.1177/082585970802400404] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Paul Mcintyre
- Department of Palliative Care, Capital District Health Authority, Halifax
| | - Simon Field
- Dalhousie University, Department of Emergency Medicine, Halifax
| | - David Maxwell
- Dalhousie University, Department of Family Medicine, Halifax, Nova Scotia, Canada
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48
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Andersen SK, Croxford R, Earle CC, Singh S, Cheung MC. Days at Home in the Last 6 Months of Life: A Patient-Determined Quality Indicator for Cancer Care. J Oncol Pract 2019; 15:e308-e315. [DOI: 10.1200/jop.18.00338] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE: Quality end-of-life care (EoLC) is a key aspect of oncology. Days at home in the last 6 months of life represents a novel, patient-driven quality indicator of EoLC. We measured days at home in a large population of patients with cancer in Ontario, Canada. Trends over time and predictors of more or less time at home were also determined. METHODS: We conducted a population-based retrospective study using health administrative data linked by unique, encoded identifiers and analyzed at the ICES. Quantile regression was used to determine significant predictors of more or less time at home. RESULTS: Of 72,987 patients who died of cancer in Ontario, Canada and met our inclusion criteria, the median number of days spent at home in the last 6 months of life was 164 (interquartile range [IQR], 144 to 175 days) of a possible 180 days. Patients with hematologic cancers spent significantly fewer days at home (156; IQR, 134 to 170 days). The strongest predictors of more time at home were male sex (+2.87 days relative to female sex; CI, 2.43 to 3.31 days) and receipt of palliative care before the last 6 months of life (+2.38 days; CI, 1.95 to 2.08 days). Additional predictors included income, age, cancer type, comorbidity burden, and health region. The majority of patients (69.7%) did not die at home. CONCLUSION: Days at home in the last 6 months of life, obtained from administrative data, can be used as a measure of quality EoLC. Predictors of days at home may prove valuable targets for future policy intervention.
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Affiliation(s)
| | | | - Craig C. Earle
- University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Simron Singh
- University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Matthew C. Cheung
- University of Toronto, Toronto, Ontario, Canada
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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49
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Davies JM, Sleeman KE, Leniz J, Wilson R, Higginson IJ, Verne J, Maddocks M, Murtagh FEM. Socioeconomic position and use of healthcare in the last year of life: A systematic review and meta-analysis. PLoS Med 2019; 16:e1002782. [PMID: 31013279 PMCID: PMC6478269 DOI: 10.1371/journal.pmed.1002782] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/14/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Low socioeconomic position (SEP) is recognized as a risk factor for worse health outcomes. How socioeconomic factors influence end-of-life care, and the magnitude of their effect, is not understood. This review aimed to synthesise and quantify the associations between measures of SEP and use of healthcare in the last year of life. METHODS AND FINDINGS MEDLINE, EMBASE, PsycINFO, CINAHL, and ASSIA databases were searched without language restrictions from inception to 1 February 2019. We included empirical observational studies from high-income countries reporting an association between SEP (e.g., income, education, occupation, private medical insurance status, housing tenure, housing quality, or area-based deprivation) and place of death, plus use of acute care, specialist and nonspecialist end-of-life care, advance care planning, and quality of care in the last year of life. Methodological quality was evaluated using the Newcastle-Ottawa Quality Assessment Scale (NOS). The overall strength and direction of associations was summarised, and where sufficient comparable data were available, adjusted odds ratios (ORs) were pooled and dose-response meta-regression performed. A total of 209 studies were included (mean NOS quality score of 4.8); 112 high- to medium-quality observational studies were used in the meta-synthesis and meta-analysis (53.5% from North America, 31.0% from Europe, 8.5% from Australia, and 7.0% from Asia). Compared to people living in the least deprived neighbourhoods, people living in the most deprived neighbourhoods were more likely to die in hospital versus home (OR 1.30, 95% CI 1.23-1.38, p < 0.001), to receive acute hospital-based care in the last 3 months of life (OR 1.16, 95% CI 1.08-1.25, p < 0.001), and to not receive specialist palliative care (OR 1.13, 95% CI 1.07-1.19, p < 0.001). For every quintile increase in area deprivation, hospital versus home death was more likely (OR 1.07, 95% CI 1.05-1.08, p < 0.001), and not receiving specialist palliative care was more likely (OR 1.03, 95% CI 1.02-1.05, p < 0.001). Compared to the most educated (qualifications or years of education completed), the least educated people were more likely to not receive specialist palliative care (OR 1.26, 95% CI 1.07-1.49, p = 0.005). The observational nature of the studies included and the focus on high-income countries limit the conclusions of this review. CONCLUSIONS In high-income countries, low SEP is a risk factor for hospital death as well as other indicators of potentially poor-quality end-of-life care, with evidence of a dose response indicating that inequality persists across the social stratum. These findings should stimulate widespread efforts to reduce socioeconomic inequality towards the end of life.
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Affiliation(s)
- Joanna M. Davies
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Katherine E. Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Javiera Leniz
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Rebecca Wilson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Irene J. Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Julia Verne
- Health Intelligence, Public Health England, Bristol, United Kingdom
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Fliss E. M. Murtagh
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
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50
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Qureshi D, Tanuseputro P, Perez R, Pond GR, Seow HY. Early initiation of palliative care is associated with reduced late-life acute-hospital use: A population-based retrospective cohort study. Palliat Med 2019; 33:150-159. [PMID: 30501459 PMCID: PMC6399729 DOI: 10.1177/0269216318815794] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND: Early palliative care can reduce end-of-life acute-care use, but findings are mainly limited to cancer populations receiving hospital interventions. Few studies describe how early versus late palliative care affects end-of-life service utilization. AIM: To investigate the association between early versus late palliative care (hospital/community-based) and acute-care use and other publicly funded services in the 2 weeks before death. DESIGN: Retrospective population-based cohort study using linked administrative healthcare data. SETTING/PARTICIPANTS: Decedents (cancer, frailty, and organ failure) between 1 April 2010 and 31 December 2012 in Ontario, Canada. Initiation time before death (days): early (⩾60) and late (⩾15 and <60). ‘Acute-care settings’ included acute-hospital admissions with (‘palliative-acute-care’) and without palliative involvement (‘non-palliative-acute-care’). RESULTS: We identified 230,921 decedents. Of them, 27% were early palliative care recipients and 13% were late; 45% of early recipients had a community-based initiation and 74% of late recipients had a hospital-based initiation. Compared to late recipients, fewer early recipients used palliative-acute care (42% vs 65%) with less days (mean days: 9.6 vs 12.0). Late recipients were more likely to use acute-care settings; this was further modified by disease: comparing late to early recipients, cancer decedents were nearly two times more likely to spend >1 week in acute-care settings (odds ratio = 1.84, 95% confidence interval: 1.83–1.85), frailty decedents were three times more likely (odds ratio = 3.04, 95% confidence interval: 3.01–3.07), and organ failure decedents were four times more likely (odds ratio = 4.04, 95% confidence interval: 4.02–4.06). CONCLUSION: Early palliative care was associated with improved end-of-life outcomes. Late initiations were associated with greater acute-care use, with the largest influence on organ failure and frailty decedents, suggesting potential opportunities for improvement.
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Affiliation(s)
- Danial Qureshi
- 1 Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,3 Institute for Clinical Evaluative Sciences, McMaster University Medical Centre, Hamilton, ON, Canada
| | | | - Richard Perez
- 3 Institute for Clinical Evaluative Sciences, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Greg R Pond
- 4 Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Hsien-Yeang Seow
- 3 Institute for Clinical Evaluative Sciences, McMaster University Medical Centre, Hamilton, ON, Canada.,4 Department of Oncology, McMaster University, Hamilton, ON, Canada
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