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Leonetti A, Peroni M, Agnetti V, Pratticò F, Manini M, Acunzo A, Marverti F, Sulas S, Rapacchi E, Mazzaschi G, Perrone F, Bordi P, Buti S, Tiseo M. Thirty-day mortality in hospitalised patients with lung cancer: incidence and predictors. BMJ Support Palliat Care 2023:spcare-2023-004558. [PMID: 37666650 DOI: 10.1136/spcare-2023-004558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Patients with lung cancer experience high rates of hospitalisation, mainly due to the high risk of complications that emerge during the natural history of the disease. We designed a retrospective, single-centre, observational study aimed at defining the clinical predictors of 30-day mortality in hospitalised patients with lung cancer. METHODS Clinical records from the first admission of patients with lung cancer to the oncology ward of the University Hospital of Parma from 1 January 2017 to 1 January 2022 were collected. RESULTS 251 consecutive patients were enrolled at the time of data cut-off. In the univariate analysis, baseline clinical predictors of 30-day mortality were Eastern Cooperative Oncology Group performance status (ECOG PS) (≥2 vs 0-1: 27.5% vs 14.8%, p=0.028), high Blaylock Risk Assessment Screening Score (BRASS) (high vs intermediate-low: 34.3% vs 11.9%, p<0.001), presence of pain (yes vs no: 24.4% vs 11.7%, p=0.009), number of metastatic sites (≥3 vs <3: 26.5% vs 13.4%, p=0.017) and presence of bone metastases (yes vs no: 29.0% vs 10.8%, p=0.001). In the multivariate analysis, high BRASS remained significantly associated with increased 30-day mortality (high vs intermediate-low; OR 2.87, 95% CI 1.21 to 6.78, p=0.016). CONCLUSION Our results suggest that baseline poor ECOG PS, high BRASS, presence of pain, high tumour burden and presence of bone metastases could be used as clinical predictors of 30-day mortality in hospitalised patients with lung cancer. In particular, the BRASS scale should be used as a simple tool to predict 30-day mortality in hospitalised patients with lung cancer.
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Affiliation(s)
| | - Marianna Peroni
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Virginia Agnetti
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Fabiana Pratticò
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Martina Manini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessandro Acunzo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Simone Sulas
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elena Rapacchi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Giulia Mazzaschi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Fabiana Perrone
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Paola Bordi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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Fernández-García A, Pérez-Ríos M, Candal-Pedreira C, Represas-Represas C, Fernández-Villar A, Santiago-Pérez MI, Rey-Brandariz J, Naveira-Barbeito G, Malvar-Pintos A, Ruano-Ravina A. Where Do Chronic Obstructive Pulmonary Disease Patients Die? 8-Year Trend, with Special Focus on Sex-Related Differences. Int J Chron Obstruct Pulmon Dis 2022; 17:1081-1087. [PMID: 35573656 PMCID: PMC9091687 DOI: 10.2147/copd.s351259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Alberto Fernández-García
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (Ciber en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Correspondence: Mónica Pérez-Ríos, Department of Preventive Medicine and Public Health, University of Santiago de Compostela, C/ San Francisco s/n, Santiago de Compostela, 15782, Spain, Tel +34-981-581237, Fax +34-981-572282, Email
| | - Cristina Candal-Pedreira
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Cristina Represas-Represas
- Respiratory Medicine, Alvaro Cunqueiro University Teaching Hospital, Vigo, Spain
- Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
| | - Alberto Fernández-Villar
- Respiratory Medicine, Alvaro Cunqueiro University Teaching Hospital, Vigo, Spain
- Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
| | - María Isolina Santiago-Pérez
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Epidemiology Unit, Galician Health Authority, Xunta de Galicia, Santiago de Compostela, Spain
| | - Julia Rey-Brandariz
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Gael Naveira-Barbeito
- Epidemiology Unit, Galician Health Authority, Xunta de Galicia, Santiago de Compostela, Spain
| | - Alberto Malvar-Pintos
- Epidemiology Unit, Galician Health Authority, Xunta de Galicia, Santiago de Compostela, Spain
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (Ciber en Epidemiología y Salud Pública/CIBERESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Beaudet MÉ, Lacasse Y, Labbé C. Palliative Systemic Therapy Given near the End of Life for Metastatic Non-Small Cell Lung Cancer. Curr Oncol 2022; 29:1316-1325. [PMID: 35323312 PMCID: PMC8947187 DOI: 10.3390/curroncol29030112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/12/2022] [Accepted: 02/21/2022] [Indexed: 12/26/2022] Open
Abstract
Background: The use of chemotherapy near end of life (EOL) for various cancers is increasing and has been shown to be associated with delayed access to palliative care (PC) and increased aggressiveness in EOL care, without any benefit on survival. Methods: This retrospective study included 90 patients with metastatic non-small cell lung cancer (NSCLC) who received at least one line of palliative systemic anticancer therapy (SACT) and died between 1 November 2014, and 31 October 2016, at Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ). Our primary objective was to evaluate the proportion of patients with NSCLC receiving SACT within 30 days of death. Secondary outcomes were to determine the mean and median delays between the administration of the last treatment and death, and to evaluate if there were differences in characteristics and outcomes (including overall survival (OS)) between patients treated or not within 30 days of death. Results: In our cohort, 22% of patients received SACT within 30 days of death. For the entire cohort, the mean delay between the last treatment and death was 94 days, and the median was 57 days. There were no statistically significant differences between the two groups in terms of baseline characteristics. Use of SACT near EOL was associated with decreased access to PC, higher rates of in hospital death, decreased use of medical aid in dying (MAiD), and a shorter median OS (4.0 vs. 9.0 months). Conclusions: In this retrospective cohort of patients with metastatic NSCLC, 22% of patients received SACT within 30 days of death, with a negative impact on access to PC, higher rates of in hospital death, decreased use of MAiD and palliative sedation, and a shorter median OS.
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Li Z, Jiang S, Xu C, Lu F, He R, Pan Z, Zhang P, Zhang L. Determinants of place of death for end-stage cancer patients: evidence from China. Int J Qual Health Care 2020; 32:41-47. [PMID: 31297534 DOI: 10.1093/intqhc/mzz064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/13/2019] [Accepted: 06/19/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To determine factors influence place of death (POD) for end-stage cancer patients and investigate how the healthcare utilization mediates on the effect of socioeconomic status (SES) on POD. DESIGN A population-based, retrospective study from July 2015 to June 2017. SETTING Yichang, China. PARTICIPANTS 894 end-stage cancer patients. MAIN OUTCOME MEASURE POD. RESULTS Patients of hospital death experience more inpatient hospitalization services (IHS) and emergency department visits. Patients enrolled in the New Rural Cooperative Medical Scheme (OR = 7.60, P < 0.001) and Urban Employee Basic Medical Insurance (OR = 28.0, P < 0.001) have higher rates of hospital death than those in the Urban Resident-based Basic Medical Insurance. Living with spouse (OR = 1.72, P = 0.019) and receiving higher education (OR = 1.92, P = 0.004), increase the likelihood of hospital death by 72% and 92%, respectively. The probability of hospital death will increase by 14% and decrease by 4% per IHS and outpatient services occur, respectively. Outpatient services (Z = -2.28, P < 0.001), and IHS (Z = 2.17, P < 0.001) mediate 1.81% and 1.89%, respectively, of the effect of health insurance on POD. The overall effect of the mediators is non-statistically significant (Z = 0.09, P = 0.825). CONCLUSION POD is mainly driven by SES. The relationship between health insurance and POD is partly mediated by outpatient services and IHS, respectively. The results corroborated that hospital and home services should be coherently bridged. Furthermore, benefit packages for end-stage cancer patients could be redesigned.
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Affiliation(s)
- Zhong Li
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, Hubei, China
| | - Shan Jiang
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chengzhong Xu
- Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Fangfang Lu
- Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Ruibo He
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, Hubei, China
| | - Zijin Pan
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, Hubei, China
| | - Pei Zhang
- Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Liang Zhang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, Hubei, China
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Tanguy-Melac A, Denis P, Pestel L, Fagot-Campagna A, Gastaldi-Ménager C, Tuppin P. Intensity of care, expenditure, place and cause of death people with lung cancer in the year before their death: A French population based study. Bull Cancer 2020; 107:308-321. [PMID: 32035648 DOI: 10.1016/j.bulcan.2019.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 11/12/2019] [Accepted: 11/16/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Health care utilization of people with lung cancer (LC) the last year of life, their causes of death and place of death and the associated expenditure have been poorly described together. Then we conducted an observational study. METHODS People with LC covered by the French health Insurance general scheme (77% of the population) who died in 2015 were identified in the national health data system, together with their health care utilization and, in 95% of cases, their causes of death. RESULTS A total of 22,899 individuals were included (mean age: 68 years, SD±11.4), 72% of whom died in short-stay hospitals (SSH), 4% in hospital-at-home, 8% in Rehab hospital, 2% in skilled nursing homes and 14% at home. One-half of these people had also a chronic respiratory tract disease and 18% another cancer. Hospital palliative care (HPC) was identified for 65% of people, but for only 9% prior to their end-of-life stay. During the last month of life, 49% of people had two or more SSH stays, 15% were admitted to an intensive care unit, 23% received a chemotherapy session (13% during the last 14 days). The main cause of death was cancer for 92% of individuals (LC for 82%) The mean expenditure during the last year of life was €43,329 per individual. DISCUSSION This study indicates high rates of intensive care unit admissions and chemotherapy during the last month of life and a SSH hospital-centered management with intensive use of HPC mainly during the end-of-life stay.
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Affiliation(s)
- Audrey Tanguy-Melac
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France
| | - Pierre Denis
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France
| | - Laurence Pestel
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France
| | - Anne Fagot-Campagna
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France
| | - Christelle Gastaldi-Ménager
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France
| | - Philippe Tuppin
- Caisse nationale d'assurance maladie (CNAM), direction de la stratégie des études et des statistiques, 26-50, avenue du Professeur André-Lemierre, 75986 Paris cedex 20, France.
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Mieras A, Pasman HRW, Onwuteaka-Philipsen BD, Dingemans AMMC, Kok EV, Cornelissen R, Jacobs W, van den Berg JW, Welling A, Bogaarts BAHA, Pronk L, Becker-Commissaris A. Is In-Hospital Mortality Higher in Patients With Metastatic Lung Cancer Who Received Treatment in the Last Month of Life? A Retrospective Cohort Study. J Pain Symptom Manage 2019; 58:805-811. [PMID: 31283970 DOI: 10.1016/j.jpainsymman.2019.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 02/06/2023]
Abstract
CONTEXT Metastatic lung cancer is an incurable disease that results in a high burden of symptoms, a poor quality of life, and an expected prognosis of less than one year after diagnosis. Treatment shortly before death may result in potential burdensome and inappropriate hospital admissions and hospital deaths. Dying at home is, at a population level, considered a quality for good end-of-life care. OBJECTIVES We examined what percentage of patients with metastatic lung cancer died inside the hospital and if hospital death, or other characteristics of the patient, oncologist or health care, were associated with treatment in the last month of life. METHODS This retrospective cohort study evaluated the medical records of 1322 patients with metastatic lung cancer who received care at one of 10 hospitals across The Netherlands and died between 1/6/2013 and 31/7/2015. Demographic and clinical characteristics were obtained from the medical records. RESULTS In total, 18% of the patients died during a hospital admission. This percentage was higher for patients who received chemotherapy (42%) or targeted therapy with tyrosine kinase inhibitors (25%) in the last month of life. Patients younger than 60 years of age, patients who received chemotherapy in the last month of life, and patients in whom tyrosine kinase inhibitors were started in the last month of life were more likely to die inside the hospital. CONCLUSION In The Netherlands, fewer than one in five patients with metastatic lung cancer died in the hospital and in-hospital death was associated with the relatively late use of chemotherapy or targeted therapy. Careful selection of patients for disease-modifying therapy might enhance the opportunity for patients to die at their preferred place.
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Affiliation(s)
- Adinda Mieras
- Department of Pulmonary Diseases, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands; Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
| | - Anne-Marie M C Dingemans
- Department of Pulmonary Diseases, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Edith V Kok
- Department of Pulmonary Diseases, Streekziekenhuis Koning Beatrix, Winterswijk, The Netherlands
| | - Robin Cornelissen
- Department of Pulmonary Diseases, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Wouter Jacobs
- Department of Pulmonary Diseases, Martini Ziekenhuis, Groningen, The Netherlands
| | | | - Alle Welling
- Department of Pulmonary Diseases, Noordwest Ziekenhuisgroep Alkmaar, Alkmaar, The Netherlands; Department of Pulmonary Diseases, Noordwest Ziekenhuisgroep Den Helder, Den Helder, The Netherlands
| | | | - Lemke Pronk
- Department of Pulmonary Diseases, Flevoziekenhuis, Almere, The Netherlands
| | - Annemarie Becker-Commissaris
- Department of Pulmonary Diseases, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Expertise Center for Palliative Care, Amsterdam, The Netherlands
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Neergaard MA, Brunoe AH, Skorstengaard MH, Nielsen MK. What socio-economic factors determine place of death for people with life-limiting illness? A systematic review and appraisal of methodological rigour. Palliat Med 2019; 33:900-925. [PMID: 31187687 DOI: 10.1177/0269216319847089] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Socio-economic factors play important roles in place of death. However, up-to-date knowledge on socio-economic determinants for place of death is warranted including analysis of collinearity between socio-economic determinants. AIM To examine associations between socio-economic determinants (social class, deprivation level in area of residence, income, education, occupation, urbanisation) and place of death among adult patients with life-limiting illnesses. Furthermore, to describe how these factors are operationalised and examined for collinearity. DESIGN A systematic review was performed (PROSPERO, record: CRD42018091218) and quality was assessed using the Newcastle-Ottawa Scale. DATA SOURCES A comprehensive search of PubMed, Embase, CINAHL, Scopus and PsycINFO was conducted for studies published from 1 January 2008 until the date of the search (23 March 2018) in English or Scandinavian languages. RESULTS Of the 1599 unique citations identified, 34 studies were eligible. Dying at home was to a high degree associated with better financial situation and living in rural areas. Furthermore, hospital death was associated with a high level of deprivation in the area of residence and being employed. Regarding educational level, we found mixed and inconclusive results. CONCLUSION Inequalities concerning place of death were found, and attention towards socio-economic inequality concerning place of death is necessary, especially in patients with a poor financial status, patients living in deprived and metropolitan areas and patients who are employed. Furthermore, we found a low degree of assessment for collinearity and adjustment of socio-economic variables. These issues should be considered in planning of future studies of socio-economic determinants for place of death.
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Wiggins N, Droney J, Mohammed K, Riley J, Sleeman KE. Understanding the factors associated with patients with dementia achieving their preferred place of death: a retrospective cohort study. Age Ageing 2019; 48:433-439. [PMID: 30806452 PMCID: PMC6503933 DOI: 10.1093/ageing/afz015] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/09/2019] [Accepted: 02/01/2019] [Indexed: 11/14/2022] Open
Abstract
Background dying in one’s preferred place is a quality marker for end-of-life care. Little is known about preferred place of death, or the factors associated with achieving this, for people with dementia. Aims to understand preferences for place of death among people with dementia; to identify factors associated with achieving these preferences. Population adults with a diagnosis of dementia who died between December 2015 and March 2017 and who were registered on Coordinate My Care, an Electronic Palliative Care Coordination System. Design retrospective cohort study. Analysis multivariable logistic regression investigated factors associated with achieving preferred place of death. Results we identified 1,047 people who died with dementia; information on preferred and actual place of death was available for 803. Preferred place of death was most commonly care home (58.8%, n = 472) or home (39.0%, n = 313). Overall 83.7% (n = 672) died in their preferred place. Dying in the preferred place was more likely for those most functionally impaired (OR 1.82 95% CI 1.06–3.13), and with a ceiling of treatment of ‘symptomatic relief only’ (OR 2.65, 95% CI 1.37–5.14). It was less likely for people with a primary diagnosis of cancer (OR 0.52, 95% CI 0.28–0.97), those who were ‘for’ cardio-pulmonary resuscitation (OR 0.32, 95% CI 0.16–0.62) and those whose record was created longer before death (51–250 days (ref <50 days) OR 0.60, 95% CI 0.38–0.94). Conclusions most people with dementia want to die in a care home or at home. Achieving this is more likely where goals of treatment are symptomatic relief only, indicating the importance of advance care planning.
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Affiliation(s)
| | - Joanne Droney
- The Royal Marsden NHS Foundation Trust, UK
- Institute of Global Health Innovation, Imperial College London, UK
| | | | - Julia Riley
- The Royal Marsden NHS Foundation Trust, UK
- Institute of Global Health Innovation, Imperial College London, UK
| | - Katherine E Sleeman
- Kings College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, UK
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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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Deckert K, Walter J, Schwarzkopf L. Factors related to and economic implications of inhospital death in German lung cancer patients - results of a Nationwide health insurance claims data based study. BMC Health Serv Res 2018; 18:793. [PMID: 30340487 PMCID: PMC6194570 DOI: 10.1186/s12913-018-3599-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/02/2018] [Indexed: 12/04/2022] Open
Abstract
Background When patients die in a hospital their quality of life is lower than when they die at home or in a hospice. Despite efforts to improve palliative care supply structures, still about 60% of lung cancer patients die in a hospital. Studies have examined factors related to inhospital death in lung cancer patients, yet none used data of a representative German population, additionally including economic aspects. This study aimed to identify factors related to inhospital death in German lung cancer patients and analysed resulting costs. Methods We analysed a dataset of health insurance claims of 17,478 lung cancer patients (incident 2009) with 3 year individual follow-up. We grouped patients into inhospital death and death elsewhere. Studied factors were indicators of healthcare utilization, palliative care, comorbidities and disease spread. We used logistic regression models with LASSO selection method to identify relevant factors. We compared all-cause healthcare expenditures for the last 30 days of life between both groups using generalized linear models with gamma distribution. Results Twelve thousand four hundred fifty-seven patients died in the observation period, thereof 6965 (55.9%) in a hospital. The key factors for increased likelihood of inhospital death were receipt of inpatient palliative care (OR = 1.85), chemotherapeutic treatments in the last 30 days of life (OR = 1.61) and comorbid Congestive Heart Failure (OR = 1.21), and Renal Disease (OR = 1.19). In contrast, higher care level (OR = 0.16), nursing home residency (OR = 0.25) and receipt of outpatient palliative care (OR = 0.25) were associated with a reduced likelihood. All OR were significant (p-values< 0.05). Expenditures in the last 30 days of life were significantly higher for patients with inhospital death (€ 6852 vs. € 33,254, p-value< 0.0001). Conclusion Findings suggest that factors associated with inhospital death often relate to previous contact with hospitals like prior hospitalizations, and treatment of the tumour or comorbidities. Additionally, factors associated with dying elsewhere relate to access to care settings which are more focused on palliation than hospitals. From these results, we can derive that implementing tools like palliative care into tumour-directed therapy might help patients make self-determined decisions about their place of death. This can possibly be achieved at reduced economic burden for SHIs. Electronic supplementary material The online version of this article (10.1186/s12913-018-3599-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karina Deckert
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377, Munich, Germany. .,Helmholtz Zentrum München GmbH, German Center for Environmental Health, Institute of Health Economics and Health Care Management, Member of Comprehensive Pneumology Center Munich (CPC-M), Member of German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany.
| | - Julia Walter
- Helmholtz Zentrum München GmbH, German Center for Environmental Health, Institute of Health Economics and Health Care Management, Member of Comprehensive Pneumology Center Munich (CPC-M), Member of German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
| | - Larissa Schwarzkopf
- Helmholtz Zentrum München GmbH, German Center for Environmental Health, Institute of Health Economics and Health Care Management, Member of Comprehensive Pneumology Center Munich (CPC-M), Member of German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
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Gao W, Huque S, Morgan M, Higginson IJ. A Population-Based Conceptual Framework for Evaluating the Role of Healthcare Services in Place of Death. Healthcare (Basel) 2018; 6:E107. [PMID: 30200247 PMCID: PMC6164352 DOI: 10.3390/healthcare6030107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 08/24/2018] [Accepted: 08/28/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND There is a significant geographical disparity in place of death. Socio-demographic and disease-related variables only explain less than a quarter of the variation. Healthcare service factors may account for some (or much) of the remaining variation but their effects have never been systematically evaluated, partly due to the lack of a conceptual framework. This study aims to propose a population-based framework to guide the evaluation of the role of the healthcare service factors in place of death. METHODS Review and synthesis of health service models that include the impact of a service component on either place of death/end of life care outcomes or service access/utilization. RESULTS The framework conceptualizes the impact of healthcare services on the place of death as starting from the end of life care policies that in turn influence service commissioning and shape healthcare service characteristics, including service type, service capacity-facilities, service location, and workforce, through which service utilization and ultimately place of death are affected. Patient socio-demographics, disease-related variables, family and community support and social care also influence place of death, but they are not the focus of this framework and therefore are grouped as needs and other environmental factors. Information on service utilization, together with the place of death, creates loop feedback to inform policy and service commission. CONCLUSIONS The framework provides guidance for analysis aiming to understand the role of healthcare services in place of death. It aids the interpretation of results in the light of existing knowledge and potentially identifies service factors that can be addressed to improve end of life care.
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Affiliation(s)
- Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, Denmark Hill, London SE5 9PJ, UK.
| | - Sumaya Huque
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, Denmark Hill, London SE5 9PJ, UK.
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, London SE1 9NH, UK.
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, Denmark Hill, London SE5 9PJ, UK.
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Kaye EC, Gushue CA, DeMarsh S, Jerkins J, Sykes A, Lu Z, Snaman JM, Blazin L, Johnson LM, Levine DR, Morrison RR, Baker JN. Illness and end-of-life experiences of children with cancer who receive palliative care. Pediatr Blood Cancer 2018; 65:10.1002/pbc.26895. [PMID: 29218773 PMCID: PMC6159948 DOI: 10.1002/pbc.26895] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 10/19/2017] [Accepted: 10/24/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND The field of pediatric palliative oncology is newly emerging. Little is known about the characteristics and illness experiences of children with cancer who receive palliative care (PC). METHODS A retrospective cohort study of 321 pediatric oncology patients enrolled in PC who died between 2011 and 2015 was conducted at a large academic pediatric cancer center using a comprehensive standardized data extraction tool. RESULTS The majority of pediatric palliative oncology patients received experimental therapy (79.4%), with 40.5% enrolled on a phase I trial. Approximately one-third received cancer-directed therapy during the last month of life (35.5%). More than half had at least one intensive care unit hospitalization (51.4%), with this subset demonstrating considerable exposure to mechanical ventilation (44.8%), invasive procedures (20%), and cardiopulmonary resuscitation (12.1%). Of the 122 patients who died in the hospital, 44.3% died in the intensive care unit. Patients with late PC involvement occurring less than 30 days before death had higher odds of dying in the intensive care unit over the home/hospice setting compared to those with earlier PC involvement (OR: 4.7, 95% CI: 2.47-8.97, P < 0.0001). CONCLUSIONS Children with cancer who receive PC experience a high burden of intensive treatments and often die in inpatient intensive care settings. Delayed PC involvement is associated with increased odds of dying in the intensive care unit. Prospective investigation of early PC involvement in children with high-risk cancer is needed to better understand potential impacts on cost-effectiveness, quality of life, and delivery of goal concordant care.
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Affiliation(s)
| | - Courtney A. Gushue
- Le Bonheur Children’s Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - Samantha DeMarsh
- Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
| | - Jonathan Jerkins
- Le Bonheur Children’s Hospital, Memphis, TN
- University of Tennessee Health Science Center, Memphis, TN
| | - April Sykes
- St. Jude Children’s Research Hospital, Memphis, TN
| | - Zhaohua Lu
- St. Jude Children’s Research Hospital, Memphis, TN
| | - Jennifer M. Snaman
- Dana-Farber Cancer Institute, Boston, MA
- Boston Children’s Hospital, Boston, MA
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13
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Fang WF, Chen YM, Lin CY, Huang KT, Kao HC, Fang YT, Huang CH, Chang YT, Wang YH, Wang CC, Lin MC. Immune profiles and clinical outcomes between sepsis patients with or without active cancer requiring admission to intensive care units. PLoS One 2017; 12:e0179749. [PMID: 28692671 PMCID: PMC5503229 DOI: 10.1371/journal.pone.0179749] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 06/02/2017] [Indexed: 12/15/2022] Open
Abstract
Background Immunoparalysis was observed in both patients with cancer and sepsis. In cancer patients, Cytotoxic T lymphocyte antigen-4 and programmed cell death protein 1/programmed death-ligand 1 axis are two key components of immunoparalysis. Several emerging therapies against these two axes gained significant clinical benefit. In severe sepsis patients, immunoparalysis was known as compensatory anti-inflammatory response syndrome and this has been suggested as an important cause of death in patients with sepsis. It would be interesting to see if immune status was different in severe sepsis patients with or without active cancer. The aim of this study was to assess the differences in immune profiles, and clinical outcomes between severe sepsis patients with or without cancer admitted to ICU. Methods A combined retrospective and prospective observational study from a cohort of adult sepsis patients admitted to three medical ICUs at Kaohsiung Chang Gung Memorial Hospital in Taiwan between August 2013 and June 2016. Results Of the 2744 patients admitted to the ICU, 532 patients with sepsis were included. Patients were divided into those with or without active cancer according to their medical history. Of the 532 patients, 95 (17.9%) patients had active cancer, and 437 (82.1%) patients had no active cancer history. Patients with active cancer were younger (p = 0.001) and were less likely to have diabetes mellitus (p < 0.001), hypertension (p < 0.001), coronary artery disease (p = 0.004), chronic obstructive pulmonary disease (p = 0.002) or stroke (p = 0.002) compared to patients without active cancer. Patients with active cancer also exhibited higher baseline lactate levels (p = 0.038), and higher baseline plasma interleukin (IL)-10 levels (p = 0.040), higher trend of granulocyte colony-stimulating factor (G-CSF) (p = 0.004) compared to patients without active cancer. The 14-day, 28-day and 90-day mortality rates were higher for patients with active cancer than those without active cancer (P < 0.001 for all intervals). Conclusions Among patients admitted to the ICU with sepsis, those with underling active cancer had higher baseline levels of plasma IL-10, higher trend of G-CSF and higher mortality rate than those without active cancer.
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Affiliation(s)
- Wen-Feng Fang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niaosung, Kaohsiung, Taiwan
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
- * E-mail: (MCL); (WFF)
| | - Yu-Mu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niaosung, Kaohsiung, Taiwan
| | - Chiung-Yu Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niaosung, Kaohsiung, Taiwan
| | - Kuo-Tung Huang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niaosung, Kaohsiung, Taiwan
| | - Hsu-Ching Kao
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niaosung, Kaohsiung, Taiwan
| | - Ying-Tang Fang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niaosung, Kaohsiung, Taiwan
| | - Chi-Han Huang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niaosung, Kaohsiung, Taiwan
| | - Ya-Ting Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niaosung, Kaohsiung, Taiwan
| | - Yi-His Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niaosung, Kaohsiung, Taiwan
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chin-Chou Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niaosung, Kaohsiung, Taiwan
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Meng-Chih Lin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Niaosung, Kaohsiung, Taiwan
- Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- * E-mail: (MCL); (WFF)
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Kalluri M, Richman-Eisenstat J. Early and Integrated Palliative Care to Achieve a Home Death in Idiopathic Pulmonary Fibrosis. J Pain Symptom Manage 2017; 53:1111-1115. [PMID: 28063858 DOI: 10.1016/j.jpainsymman.2016.12.344] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/19/2016] [Accepted: 12/27/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Meena Kalluri
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
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