Factors associated with aggressive end of life cancer care

TY - JOUR

T1 - Factors associated with aggressive end of life cancer care

AU - Henson, Lesley A

AU - Gomes, Barbara

AU - Koffman, Jonathan

AU - Daveson, Barbara A

AU - Higginson, Irene J

AU - Gao, Wei

AU - BuildCARE

PY - 2016/3/1

Y1 - 2016/3/1

N2 - BACKGROUND: Many patients with cancer experience aggressive care towards the end of life (EOL) despite evidence of an association with poor outcomes such as prolonged pain and overall dissatisfaction with care.PURPOSE: To investigate socio-demographic, clinical and community health care service factors associated with aggressive EOL cancer care.METHODS: An analysis of pooled data from two mortality follow-back surveys was performed. Aggressive EOL care was defined as greater than or equal to one of the following indicators occurring during the last 3 months of life: greater than or equal to two emergency department visits, ≥30 days in hospital and death in hospital.RESULTS: Of the 681 included patients, 50.1 % were men and mean age at death was 75 years. The majority of patients (59.3 %, 95 % confidence interval (CI) 55.6-63.0 %) experienced at least one indicator of aggressive EOL care: 29.7 % experienced greater than or equal to two ED visits, 17.1 % spent ≥30 days in hospital and 37.9 % died in hospital. Patients with prostate or haematological cancer were more likely to experience aggressive EOL care (adjusted odds ratio (AOR) 4.36, 95 % CI 1.39-13.70, and 4.16, 95 % CI 1.38-12.47, respectively, reference group lung cancer). Patients who received greater than five general practitioner (GP) home visits (AOR 0.37, 95 % CI 0.17-0.82, reference group no GP visits) or had contact with district nursing (AOR 0.48, 95 % CI 0.28-0.83, reference group no contact) or contact with community palliative care services (AOR 0.27, 95 % CI 0.15-0.49, reference group no contact) were less likely to experience aggressive EOL care. No association was found between aggressive EOL care and patients' age, gender, marital, financial or health status.CONCLUSIONS: Community health care services, in particular contact with community palliative care, are associated with a significant reduction in the odds of cancer patients receiving aggressive EOL care. Expansion of such services may help address the current capacity crises faced by many acute health care systems.

AB - BACKGROUND: Many patients with cancer experience aggressive care towards the end of life (EOL) despite evidence of an association with poor outcomes such as prolonged pain and overall dissatisfaction with care.PURPOSE: To investigate socio-demographic, clinical and community health care service factors associated with aggressive EOL cancer care.METHODS: An analysis of pooled data from two mortality follow-back surveys was performed. Aggressive EOL care was defined as greater than or equal to one of the following indicators occurring during the last 3 months of life: greater than or equal to two emergency department visits, ≥30 days in hospital and death in hospital.RESULTS: Of the 681 included patients, 50.1 % were men and mean age at death was 75 years. The majority of patients (59.3 %, 95 % confidence interval (CI) 55.6-63.0 %) experienced at least one indicator of aggressive EOL care: 29.7 % experienced greater than or equal to two ED visits, 17.1 % spent ≥30 days in hospital and 37.9 % died in hospital. Patients with prostate or haematological cancer were more likely to experience aggressive EOL care (adjusted odds ratio (AOR) 4.36, 95 % CI 1.39-13.70, and 4.16, 95 % CI 1.38-12.47, respectively, reference group lung cancer). Patients who received greater than five general practitioner (GP) home visits (AOR 0.37, 95 % CI 0.17-0.82, reference group no GP visits) or had contact with district nursing (AOR 0.48, 95 % CI 0.28-0.83, reference group no contact) or contact with community palliative care services (AOR 0.27, 95 % CI 0.15-0.49, reference group no contact) were less likely to experience aggressive EOL care. No association was found between aggressive EOL care and patients' age, gender, marital, financial or health status.CONCLUSIONS: Community health care services, in particular contact with community palliative care, are associated with a significant reduction in the odds of cancer patients receiving aggressive EOL care. Expansion of such services may help address the current capacity crises faced by many acute health care systems.

KW - Community health services

KW - Emergency service

KW - Hospital

KW - Hospital mortality

KW - Neoplasms

KW - Palliative care

KW - Terminal care

UR - http://www.scopus.com/inward/record.url?scp=84938797858&partnerID=8YFLogxK

U2 - 10.1007/s00520-015-2885-4

DO - 10.1007/s00520-015-2885-4

M3 - Article

C2 - 26253587

SN - 0941-4355

VL - 24

SP - 1079

EP - 1089

JO - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

JF - Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer

IS - 3

ER -