Is specialized palliative cancer care associated with use of antineoplastic treatment at the end of life? A population-based cohort study

2018 ◽  
Vol 32 (9) ◽  
pp. 1509-1517 ◽  
Author(s):  
Kirstine Skov Benthien ◽  
Mathilde Adsersen ◽  
Morten Aagaard Petersen ◽  
Eva Soelberg Vadstrup ◽  
Per Sjøgren ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
End Of Life ◽  
Female Gender ◽  
Population Based ◽  
Hospital Units ◽  
Hematological Cancers ◽  
Specialized Palliative Care ◽  
Antineoplastic Treatment ◽  
Breast And Prostate Cancer

Background: The use of chemotherapy in the last 14 days of life should be as low as possible. Aim: To study the factors related to the use of chemotherapy in the last 14 days of life and the factors related to concurrent antineoplastic treatment and specialized palliative care. Design: This was a population-based cohort study. The data were collected from the Danish Register of Causes of Death, the Danish National Patient Register, and the Danish Palliative Care Database. Analyses were descriptive and multivariate logistic regression. Setting/participants: Cancer decedents between 2010 and 2013 in the Capital Region of Denmark. Results: During the study period, 17,246 individuals died of cancer and 33% received specialized palliative care. In the last 14 days of life, 4.2% received chemotherapy. Younger patients and patients with hematological cancers were more likely to receive chemotherapy in the last 14 days of life. Receiving specialized palliative care was associated with a lower risk of receiving chemotherapy in the last 14 days of life—odds ratio 0.15 for hospices and 0.53 for palliative hospital units. A total of 8% of the population received concurrent antineoplastic treatment and specialized palliative care. Female gender, younger age, and breast and prostate cancer were significantly associated with this concurrent model. Conclusion: Overall, the incidence of antineoplastic treatment in the last 14 days of life was low compared to other studies. Patients in specialized palliative care had a reduced risk of receiving chemotherapy at the end of life.

Persistent socioeconomic inequalities in location of death and receipt of palliative care: A population-based cohort study

2020 ◽  
Vol 34 (10) ◽  
pp. 1393-1401
Author(s):  
Luke Mondor ◽  
Walter P Wodchis ◽  
Peter Tanuseputro
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
End Of Life ◽  
Terminal Illness ◽  
Home Visits ◽  
Population Based ◽  
Relative Index ◽  
Deprived Neighbourhoods ◽  
Location Of Death ◽  
Index Of Inequality

Background: Providing equitable care to patients in need across the life course is a priority for many healthcare systems. Aim: To estimate socioeconomic inequality trends in the proportions of decedents that died in the community and that received palliative care within 30 days of death (including home visits and specialist/generalist physician encounters). Design: Cohort study based on health administrative data. Socioeconomic position was measured by area-level material deprivation. Inequality gaps were quantified annually and longitudinally using the slope index of inequality (absolute gap) and relative index of inequality (relative gap). Setting/Participants: A total of 729,290 decedents aged ⩾18 years in Ontario, Canada from 2009 to 2016. Results: In 2016, the modelled absolute gap (corresponding 95% confidence interval) between the most- and least-deprived neighbourhoods in community deaths was 4.0% (2.9–5.1%), which was 8.6% (6.2–10.9%) of the overall mean (46.6%). Relative to 2009, these inequalities declined modestly. Inequalities in 2016 were evident for palliative home visits (6.8% (5.8–7.8%) absolute gap, 26.3% (22.5–30.0%) relative gap) and for physician encounters (6.8% (5.7–7.9%) absolute gap, 13.2% (11.0–15.3%) relative gap), and widened from 2009 for physician encounters only on the absolute scale. Inequalities varied considerably across disease trajectories (organ failure, terminal illness, frailty, and sudden death). Conclusion: Key measures of end-of-life care are not achieved equally across socioeconomic groups. These data can be used to inform policy strategies to improve delivery of palliative and end-of-life services.

scholarly journals Factors Related to Specialized Palliative Care Use and Aggressive Care at End of Life in Japanese Patients With Advanced Solid Cancers: A Cohort Study

2021 ◽  
Author(s):  
Yusuke Hiratsuka ◽  
Takayuki Oishi ◽  
Mitsunori Miyashita ◽  
Tatusya Morita ◽  
Jennifer W Mack ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
End Of Life ◽  
Advanced Cancer ◽  
Multivariate Logistic Regression Analysis ◽  
Japanese Patients ◽  
University Hospital ◽  
Younger Age ◽  
Specialized Palliative Care ◽  
Aggressive Care

Abstract Purpose:This study aimed to identify factors associated with specialized palliative care (SPC) use and aggressive care at the end of life (EOL) among Japanese patients with advanced cancer. Methods:This single-center, follow-up cohort study involved patients with advanced cancer who received chemotherapy at Tohoku University Hospital. Patients were surveyed at enrollment, and we followed clinical events for 5 years from enrollment in the study. We performed multivariate logistic regression analysis to identify independent factors related to SPC use and chemotherapy in the last month before death.Results:We analyzed a total of 135 patients enrolled between January 2015 and January 2016. No patients were admitted to the intensive care unit, and few received resuscitation or ventilation. We identified no factors significantly associated with SPC use. Meanwhile, younger age (20–59 years, odds ratio [OR] 4.10; 95% confidence interval [CI] 1.30–12.91; p=0.02) and no receipt of SPC (OR 4.32; 95% CI 1.07–17.37; p=0.04) were associated with chemotherapy in the last month before death.Conclusion:Younger age and a lack of SPC were associated with chemotherapy at the EOL in patients with advanced cancer in Japan. These findings suggest that Japanese patients with advanced cancer may benefit from access to SPC.

scholarly journals What are the prevalence and predictors of psychosocial healthcare among patients with heart disease? A nationwide population-based cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037691
Author(s):  
Line Zinckernagel ◽  
Annette Kjær Ersbøll ◽  
Teresa Holmberg ◽  
Susanne S Pedersen ◽  
Helle Ussing Timm ◽  
...  
Keyword(s):  
Cohort Study ◽  
Heart Disease ◽  
Labour Force ◽  
Disease Onset ◽  
Psychosocial Rehabilitation ◽  
Female Gender ◽  
Population Based ◽  
Multivariable Logistic Regression Analysis ◽  
Patient Reported ◽  
Patients Experience

ObjectivesPsychosocial healthcare is recommended, but little is known about how patients perceive the level of care and whether subgroups of patients experience less psychosocial healthcare than others. We examined the prevalence of patient-reported psychosocial healthcare and factors predicting patient-reported lack of psychosocial healthcare among patients with heart disease.DesignA cohort study.SettingDenmark, nationwide.ParticipantsA registry-based random sample of 5000 patients with incident heart disease in 2013.MeasuresPatient-reported psychosocial healthcare was obtained from a survey and potential predictors before disease onset from registries. We used multivariable logistic regression analysis to determine predictors of patient-reported lack of care.ResultsWe received responses from 56%; 40% reported lacking information on psychosocial aspects, 51% lacking psychosocial rehabilitation and support and 32% reported lacking both types of psychosocial healthcare. The type of heart disease was the strongest predictor of patient-reported lack of psychosocial healthcare, especially among patients with atrial fibrillation (OR: 3.11–3.98). Older age (OR: 1.48–2.05), female gender (OR: 1.27–1.53) and no contact with general practitioner (OR: 1.47–1.84) also predicted patient-reported lack of psychosocial healthcare. Patients outside the labour force (OR: 1.29) and living in the capital region (OR: 1.50) more frequently reported lacking psychosocial rehabilitation and support, and patients with recent (OR: 1.63) or past (OR: 1.33) anxiety or depression and severe comorbidities (OR: 1.34) more frequently reported lacking both types of psychosocial healthcare.ConclusionsMany patients with heart disease reported lacking psychosocial healthcare. Importantly, patients who most need psychosocial healthcare are not those who report receiving it. Our results call for action to translate guidelines into clinical practice.

scholarly journals End-Of-Life Discussions Reduce The Utilization of Life-Sustaining Treatments During The Last Three Months of Life in Cancer Patients : A Nationwide Population-Based Cohort Study

2021 ◽  
Author(s):  
Shang-Yih Chan ◽  
Yun-Ju Lai ◽  
Yu-Yen Hsin Chen ◽  
Shuo-Ju Chiang ◽  
Yi-Fan Tsai ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiopulmonary Resuscitation ◽  
End Of Life ◽  
Cancer Patients ◽  
Medical Records ◽  
Population Based ◽  
Lower Likelihood ◽  
The Mean ◽  
The Impact ◽  
To Receive

Abstract Purpose Studies to examine the impact of end-of-life (EOL) discussions on the utilization of life-sustaining treatments near death were limited and had inconsistent findings. This nationwide population-based cohort study determined the impact of EOL discussions on the utilization of life-sustaining treatments in the last three months of life in Taiwanese cancer patients. Methods This cohort study included adult cancer patients from 2012–2018, which were confirmed by pathohistological reports. Life-sustaining treatments during the last three months of life included cardiopulmonary resuscitation, intubation, and defibrillation. EOL discussions in cancer patients were confirmed by their medical records. Association of EOL discussions with utilization of life-sustaining treatments were assessed using multiple logistic regression. Results Of 381,207 patients, the mean age was 70.5 years and 19.4% of the subjects utilized life-sustaining treatments during the last three months of life. After adjusting for other covariates, those who underwent EOL discussions were less likely to receive life-sustaining treatments during the last three months of life compared to those who did not (Adjusted odds ratio [AOR]: 0.82; 95% confidence interval [CI]: 0.80–0.84). Considering the type of treatments, EOL discussions correlated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR = 0.43, 95% CI: 0.41–0.45), endotracheal intubation (AOR = 0.87, 95%CI: 0.85–0.89), and defibrillation (AOR = 0.52, 95%CI: 0.48–0.57). Conclusion EOL discussions correlated with a lower utilization of life-sustaining treatments during the last three months of life among cancer patients. Our study supports the importance of providing these discussions to cancer patients to better align care with preferences during the EOL treatment.

scholarly journals Clustering of 27,525,663 Death Records from the United States Based on Health Conditions Associated with Death: An Example of big Health Data Exploration

2019 ◽  
Vol 8 (7) ◽  
pp. 922
Author(s):  
Daisy J.A. Janssen ◽  
Simon Rechberger ◽  
Emiel F.M. Wouters ◽  
Jos M.G.A. Schols ◽  
Miriam J. Johnson ◽  
...  
Keyword(s):  
United States ◽  
Palliative Care ◽  
End Of Life ◽  
Cause Of Death ◽  
The United States ◽  
Population Based ◽  
Health Conditions ◽  
Mortality Data ◽  
Self Organizing Map ◽  
Multiple Health

Background: Insight into health conditions associated with death can inform healthcare policy. We aimed to cluster 27,525,663 deceased people based on the health conditions associated with death to study the associations between the health condition clusters, demographics, the recorded underlying cause and place of death. Methods: Data from all deaths in the United States registered between 2006 and 2016 from the National Vital Statistics System of the National Center for Health Statistics were analyzed. A self-organizing map (SOM) was used to create an ordered representation of the mortality data. Results: 16 clusters based on the health conditions associated with death were found showing significant differences in socio-demographics, place, and cause of death. Most people died at old age (73.1 (18.0) years) and had multiple health conditions. Chronic ischemic heart disease was the main cause of death. Most people died in the hospital or at home. Conclusions: The prevalence of multiple health conditions at death requires a shift from disease-oriented towards person-centred palliative care at the end of life, including timely advance care planning. Understanding differences in population-based patterns and clusters of end-of-life experiences is an important step toward developing a strategy for implementing population-based palliative care.

Sign in / Sign up

Export Citation Format

Share Document