Palliative Chemotherapy Near the End of Life in Oncology Patients

2018 ◽  
Vol 35 (9) ◽  
pp. 1215-1220 ◽  
Author(s):  
Zhe Zhang ◽  
Meng-Lei Chen ◽  
Xiao-Li Gu ◽  
Ming-Hui Liu ◽  
Wei-Wei Zhao ◽  
...  
Keyword(s):  
End Of Life ◽  
Medical Records ◽  
Palliative Chemotherapy ◽  
Metastatic Cancer ◽  
Performance Status ◽  
Age Groups ◽  
Treatment Strategies ◽  
Cancer Center ◽  
Eol Care ◽  
To Receive

Background: Although palliative chemotherapy during end-of-life (EOL) care is used to relieve symptoms in patients with metastatic cancer, chemotherapy may lead to more aggressive EOL care. We evaluated the use of and variables associated with chemotherapy at EOL. Methods: This study included data from patients who died from advanced cancer and underwent palliative chemotherapy between April 2007 and May 2017 at the Department of Palliative Care of Fudan University, Shanghai Cancer Center. Data were collected from hospital medical records. Univariate and multivariate analyses were conducted to identify the variables that independently predicted the use of palliative chemotherapy. Results: Among the 542 patients in the study, 85 (15.7%) underwent palliative chemotherapy during the last month and 28 (5.2%) underwent it during the last 2 weeks of life. Age <59 years (odds ratio [OR] = 1.82, 95% confidence interval [CI]: 1.51-2.61), performance status <3 (OR = 3.73, 95% CI: 1.46-4.67), and cardiopulmonary resuscitation (OR = 3.88, 95% CI: 3.01-5.34) were independently associated with the use of chemotherapy. The use of palliative chemotherapy during the last year of life differed significantly by patient age ( P < .001). Conclusion: The observed chemotherapy rates of 15.7% during the last month of life and 5.2% during the last 2 weeks of life are in line with international recommendations. This study showed that palliative chemotherapy is associated with more aggressive EOL care and indicates that younger patients and those with lower performance status are more likely to receive palliative chemotherapy. Significant variations in EOL treatment strategies among different age groups during the last year of life were also identified.

scholarly journals Chemotherapy and Targeted Therapy Near the end of life Affects Aggressiveness of Palliative Care

2020 ◽  
Author(s):  
Wen-Wu Cheng ◽  
Zhe Zhang ◽  
Meng-Lei Chen ◽  
Xiao-Li Gu
Keyword(s):  
Targeted Therapy ◽  
Cardiopulmonary Resuscitation ◽  
End Of Life ◽  
Palliative Chemotherapy ◽  
Metastatic Cancer ◽  
Performance Status ◽  
Cancer Center ◽  
Integrated Therapy ◽  
The Difference ◽  
To Receive

Abstract Background: In patients with advanced cancer, considering the increased application of targeted therapy and immunotherapies, we explored the difference between indicators of chemotherapy and targeted therapy in the last month of life.Methods: Electronic medical data of patients who died from metastatic cancer and received targeted therapy and palliative chemotherapy from April 2007 to December 2018 at the Department of Integrated Therapy, Fudan University Shanghai Cancer Center were analyzed retrospectively. To determine those variables that were judged to be independent predictors of the use of palliative chemotherapy and targeted therapy, and the differences between them, univariate and multivariate analyses were used.Results: Of the 585 patients included in the study, 87 (14.9%) received palliative chemotherapy and 125 (21.3%) underwent targeted therapy during the last month. Patients who received continued chemotherapy within the last month were subjected to more intensive treatment (admitted to an intensive care unit (ICU) in the last month of life (OR, 2.33; CI [1.91–2.92], P < 0.001), and received cardiopulmonary resuscitation(OR, 4.18; CI [2.91–5.40],P < 0.001)), than those who did not. Analysis of subgroups showed that the lung cancer was independently associated with targeted therapy, and admission to an ICU was independently associated with palliative chemotherapy.Conclusions: Younger patients without complications and with better performance status were more likely to receive chemotherapy. Lower rates of cardiopulmonary resuscitation and admission to ICU correlated with receipt of targeted therapy at the end of life compared with those who received chemotherapy in the last 30 days.

Use of Palliative Chemo- and Radiotherapy at the End of Life in Patients With Cancer: A Retrospective Cohort Study

2016 ◽  
Vol 34 (9) ◽  
pp. 801-805 ◽  
Author(s):  
Zhe Zhang ◽  
Xiao-Li Gu ◽  
Meng-Lei Chen ◽  
Ming-Hui Liu ◽  
Wei-Wei Zhao ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
End Of Life ◽  
Medical Records ◽  
Palliative Chemotherapy ◽  
Performance Status ◽  
Terminally Ill ◽  
Cardiovascular Complications ◽  
Cancer Center ◽  
Patients With Cancer ◽  
Terminally Ill Patients

Background: Administration of chemotherapy and radiotherapy near the end of life is a frequently discussed issue nowadays. We have evaluated the factors associated with the use of chemotherapy and radiotherapy at the end of life among terminally ill patients in China. Methods: This study included the data from patients who had died from advanced cancer who underwent palliative chemotherapy and radiotherapy between January 2007 and December 2013 at the Department of Palliative Care of Fudan University, Shanghai Cancer Center. Data were collected from hospital medical records. Univariate and multivariate analyses were conducted to identify the factors independently associated with the use of chemo- and radiotherapy. Results: Among the 410 patients included (median age, 68 years; range, 18-93; 53% males), 47 (11.5%) underwent palliative chemotherapy and 28 (6.8%) underwent radiotherapy in the last 30 days. Age <65 years (odds ratio [OR]: 1.33, 95% confidence interval [CI]: 1.06-2.88), performance status <3 (OR: 3.95; 95% CI: 1.56-5.07), and cardiopulmonary resuscitation (OR: 4.09, 95% CI: 2.66-5.34) were independently associated with the use of chemotherapy. Performance status <3 (OR: 4.06, 95% CI: 2.17-5.83) and cardiopulmonary resuscitation (OR: 5.28, 95% CI: 3.77-7.21) were independently associated with the use of radiotherapy. Conclusion: The findings indicate that younger patients with a lower performance status who do not have complications are more likely to opt for chemo- or radiotherapy. Further, the use of palliative chemo- and radiotherapy should be considered carefully in terminally ill patients with cancer, as they seem to indicate a higher risk of cardiovascular complications requiring resuscitation.

A systematic review of end of life cancer care in the elderly population in Qatar: A retrospective cohort study.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 87-87
Author(s):  
Azza Adel Hassan ◽  
Ayman Allam ◽  
Cicy Mary Jacob
Keyword(s):  
Colorectal Cancer ◽  
Cohort Study ◽  
End Of Life ◽  
Elderly Population ◽  
Performance Status ◽  
Age Groups ◽  
The Elderly ◽  
Place Of Death ◽  
Common Diagnosis ◽  
Eol Care

87 Background: Managing cancer in the elderly ( ≥ 65 years of age) is quite challenging as a result of associated comorbidities, poor performance status and the expected lower tolerance to treatment. The aim of the present study is to report on the demographics of cancer in the elderly population at NCCCR, also to analyze different indicators constituting End of Life (EoL) care in this subgroup of patients. Methods: Elderly patients ( ≥ 65 years of age) presenting with cancer diagnosis to NCCCR between January 01, 2009 till December 31, 2013 constituted the cohort study group. Their medical records were reviewed for the following items: Diagnosis, Performance status, age, comorbidities, treatment received, place of death, Length of Stay (LOS) during last hospitalizations as well as aggressiveness of care at EoL. Patients were then subdivided into 3 age groups: 65-74 years (n = 175), 75-79 years (n = 63) and ≥ 80 years (n = 54). Results: The most common diagnosis was colorectal cancer (42%, 35% and 46% in the 3 age groups respectively). The palliative ward was the most common place of death (43%, 46% and 36% respectively) followed by Medical ICU (26%, 14% and 20% respectively). The median survival from the date of admission in last hospitalization was not different in the 3 age groups (9.4 days vs 9.11 days vs 8.8 days respectively). There was no statisticallly significant differences between the 3 age groups as regards any of the 6 indicators of aggressive care. However, a high percentage of ICU admissions (ranging between 20% - 29%) was reported across all age groups. Conclusions: Colorectal cancer is the most common type of cancer in elderly population in Qatar. Admission to ICU in the last month of life was high, ranging between 20-29%. The mean LOS of last hospitalization was short ranging between 8.8 - 9.4 days. These findings would warrant the development of a needed community palliative care service that would allow this group of patients to receive their EOL care at home, rather than in hospital.

scholarly journals Patient Characteristics and Outcomes in Adolescents and Young Adults (AYA) with Acute Myeloid Leukemia (AML): Princess Margaret Cancer Centre Experience

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2609-2609
Author(s):  
Muhned Alhumaid ◽  
Georgina S Daher-Reyes ◽  
Wilson Lam ◽  
Arjun Law ◽  
Tracy Murphy ◽  
...  
Keyword(s):  
Board Of Directors ◽  
Older Patients ◽  
Myeloid Leukemia ◽  
Research Funding ◽  
Age Groups ◽  
Treatment Strategies ◽  
Patient Characteristics ◽  
Cancer Center ◽  
Advisory Committees ◽  
Disease Behavior

Introduction: Clinical outcomes of acute myeloid leukemia (AML) in adolescents and young adults (AYA) are rarely reported as an isolated subgroup. Treatments vary little across age groups, and treatment intensity depends upon comorbid conditions and performance status. Optimal treatment strategies focused on disease behavior, biological factors, and the distinct needs of this subset of AML patients remain elusive. The purpose of this retrospective analysis is to determine the characteristics and outcomes of AYA AML patients treated at a specialized adult leukemia cancer center in comparison to older adults with AML (40-60 years). Methods: A retrospective analysis was performed on all patients treated at Princess Margaret Cancer Center from 2008-2018. Patients with acute promyelocytic leukemia were excluded. Clinical characteristics, treatment strategies, and survival outcomes were recorded for all patients. Overall survival (OS) and disease-free survival (DFS) rates were calculated using the Kaplan-Meier product-limit method and the impact of covariates were assessed using the Log-rank test. Finally, we compared the outcomes of AYA patients treated at our centre between 2015-2018 with older patients. Results: A total of 175 patients aged 18-39 were identified. Patient characteristics are shown in (Table 1). Cytogenetic were available in 163 patients. Based on MRC criteria, 27 (16%) were favorable risk, intermediate in 95 (54%), adverse in 39 (22%), and missing/failed in 14(8%). NPM1 status was available in 110 patients of whom 38 (35%) were positive. FLT3-ITD was available in 67 patients with 24 (36%) positive. Both mutations were present in 13 (54%) patients. There were no significant differences in terms of risk stratification based on cytogenetic and molecular markers based on age (18-29 vs.30-39) (P= 0.98). Most patients 172 (98%) received induction, 157 (91%) with 3+7, and 15 (9%) with FLAG-IDA. Complete remission (CR) was achieved in 133 (77%) after first induction [120 (76%) after 3+7 and 11 (73%) after FLAG-IDA]. Induction related mortality was low (2%). Of the 39 who did not achieve CR, thirty-four patients received re-induction (13 FLAG-IDA, 16 NOVE-HiDAC, 5 others) with CR in 21 (62%). Overall, 154 (89.5%) achieved CR1. Sixty-four (42%) proceeded to hematopoietic stem cell transplantation (HSCT) in CR1. 59 (38%) patients relapsed in CR1 with 8 (12%) relapsing post HSCT. Fifty-five (5 post HSCT) patients received reinduction with 30 (51%) (2 after HSCT) achieving CR2. Fifteen patients received HSCT in CR2. OS and DFS at 2 years were 62% (95% CI 0.53-0.69) and 50% (95% CI 0.41-0.57), respectively. Stratified by cytogenetic risk, OS was 81% for favorable risk, 61% for intermediate, and 50% for adverse risk (P=0.0001), respectively. DFS in these groups was 85%, 57%, and 46 % (P=0.0025), respectively. We further compared outcomes in the 18-29y and 30-39y age groups. The OS was 61.9% compared to 62.5% (P=0.91) and DFS of 52.1% compared to 47% (P=0.65) respectively. On univariate analysis for OS and DFS, cytogenetic risk stratification was the only significant variable (P=0.0004 and P=0.0042). We then compared the outcomes 67 sequential patients aged I8-39 treated from 2014-2018, with those of 176 sequential patients aged 40-60 treated during the same period (table 2). OS at 2 years was not statistically higher in the younger group compared to the older group (66.7% vs. 61.2%, P=0.372). While relapse rate was lower in older patients (15.5% vs. 22.6%, P=0.093), NRM was higher in older patients (29.7% vs. 18.8%,P=0.094). Conclusion: AYA pts. occupy a unique niche amongst AML as a whole. While treatment responses have improved in general, there may be potential for further gains in these patients. Increased tolerance for more intense treatment strategies as well as the incorporation of novel agents into standard treatment protocols may provide a means to optimize care in AYA patients. Finally, research is needed to elucidate biological mechanisms and predictors of disease behavior instead of arbitrary, age-stratified treatment schema. Disclosures McNamara: Novartis Pharmaceutical Canada Inc.: Consultancy. Schimmer:Jazz Pharmaceuticals: Consultancy; Medivir Pharmaceuticals: Research Funding; Novartis Pharmaceuticals: Consultancy; Otsuka Pharmaceuticals: Consultancy. Schuh:Astellas: Honoraria, Membership on an entity's Board of Directors or advisory committees; AbbVie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Teva Canada Innovation: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees; Agios: Honoraria; Jazz: Honoraria, Membership on an entity's Board of Directors or advisory committees. Maze:Pfizer Inc: Consultancy; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees. Yee:Astellas: Membership on an entity's Board of Directors or advisory committees; Millennium: Research Funding; Takeda: Membership on an entity's Board of Directors or advisory committees; Astex: Research Funding; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Merck: Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; MedImmune: Research Funding; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Hoffman La Roche: Research Funding. Minden:Trillium Therapetuics: Other: licensing agreement. Gupta:Incyte: Honoraria, Research Funding; Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Sierra Oncology: Honoraria, Membership on an entity's Board of Directors or advisory committees.

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.

Chemotherapy at the end of life: Do we know when to stop?

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24005-e24005
Author(s):  
Renana Barak ◽  
Einav Zagagi Yohay ◽  
Barliz Waissengrin ◽  
Ido Wolf
Keyword(s):  
End Of Life ◽  
Disease Duration ◽  
Performance Status ◽  
Poor Quality ◽  
Palliative Intent ◽  
Care Services ◽  
Palliative Care Services ◽  
Eol Care ◽  
Oncologic Treatment

e24005 Background: Aggressive end-of-life (EOL) care in cancer patients, especially the administration of chemotherapy, is considered a poor-quality measure, that may divert the treatment course from its' main palliative intent. Decisions taken at EOL are more than evidence-based and often rely on cultural and personal prospects. The universal and free Israeli health care system enables the administration of active treatment without financial or regulatory barriers, even at EOL. Two major advancements in recent years were the implementation of national at-home palliative care services and the approval of targeted and immunotherapies for advanced cancers. We hypothesized that these changes will reduce the use of chemotherapy at EOL. Methods: We sampled consecutive patients treated at a tertiary oncology center who died of advanced cancers between January 2019 to August 2020, and examined the administration of oncologic treatments near EOL. Results: A total of 294 patients were included. Their median age was 67 and 147 were men, 64% (189) of the patients received oncologic treatment during the last month before death, chemotherapy was administered in nearly two-thirds of the cases, 64% (121), followed by immunotherapy (21%, 40), targeted therapy (10%, 19) and a clinical trial (5%, 9). Neither age (P = 0.4), gender (P = 0.9), performance status (P = 0.8), disease duration (P = 0.5), and type of previous oncologic treatment (P = 0.3) were associated with aggressive EOL care. Conclusions: Our data demonstrate that in the absence of any regulatory or financial limitations, an aggressive EOL care may be administered to the majority of patients, regardless of age, performance status or disease duration. Despite increasing use of immunotherapy and targeted therapies and despite its’ toxicity profile and low beneficial effect at this stage, chemotherapy remained the most commonly used type of treatment. These data call for the implementation of educational measures and appropriate universal guidelines, aiming at improving quality of treatment at the EOL, focusing on quality of life rather than the elusive potential of extending life.

Palliative cancer therapy during end of life at a regional cancer center in Norway in 2005 and 2009.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9040-9040
Author(s):  
Mari Aas Gynnild ◽  
Malin Anshushaug ◽  
Stein Kaasa ◽  
Anne Kvikstad ◽  
Bjørn Henning Grønberg
Keyword(s):  
Cancer Therapy ◽  
Medical Records ◽  
Median Overall Survival ◽  
Hematological Malignancy ◽  
Performance Status ◽  
National Registry ◽  
Cancer Center ◽  
Cancer Type ◽  
Case Methods ◽  
Curative Intention

9040 Background: With increasing number of available therapies, there is a risk that patients (pts) are overtreated. Palliative cancer therapy is mostly recommended for pts with good Performance Status (PS). In one study, 42 % of pts received chemotherapy (CTx) during the last 30 days of life – suggesting that this may not always be the case. Methods: All pts who, according to the national registry, died from cancer in our region in 2005 and 2009 were analyzed. Data were collected from individual medical records. Endpoints: Time from the end of palliative cancer therapy until death. Whether there were differences depending on age; type of cancer; year of death or if they were seen at a palliative care unit (PCU). PS when the last cancer therapy was initiated. Results: 616 pts died in 2005; 599 in 2009. We excluded 495 pts: No cancer therapy (n=260); no information of cancer (n=101); last therapy with curative intention (n=83); hematological malignancy (n=51). Median age 71 (6 - 99); 49 % men; median overall survival from diagnosis: 16.9 mos. Last therapy was radiotherapy (RT): 31 %; CTx: 40 %; hormonal: 15 %; surgery: 11 %. 4 % died from treatment complications. Median time from start of last CTx or RT until death: 100 days; from end of last CTx or RT: 63 days. Younger pts received more CTx and RT in the last 30 days: Age < 60: 28 %; 60-70: 23 % and 70+: 12 % (p<.001). The table shows the use of CTx and RT the last 30 and 14 days for the most common cancers. Among those who got CTx in the last 30 days (n=74); 54 % had PS 2; 14 % PS 3-4. Among those who got RT in the last 30 days (n=61), 31 % had PS 2; 54 % PS 3-4. Of the 49 % referred to the PCU, fewer received CTx or RT in the last 30 days (PCU: 14 %, no PCU: 22 %; p=.002) and 14 days (PCU: 5 %, no PCU: 12 %; p<.001). Conclusions: Many pts received cancer therapy the last month of life. The percentage varies with age, cancer type and was lower in 2009 than in 2005. Pts seen at the PCU received less CTx and RT. Many pts had a poorer PS at the start of last cancer therapy than recommended. [Table: see text]

Characteristics of patients (pts) receiving end of life treatment (EOLT) at an NCI-Designated Cancer Center.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18245-e18245
Author(s):  
Kevin Do ◽  
Sarmad Sadeghi ◽  
Peggy Matsuura ◽  
Gwendoyn Lynch ◽  
Afsaneh Barzi
Keyword(s):  
End Of Life ◽  
Cancer Diagnosis ◽  
Expert Panel ◽  
Renal Cell Carcinoma Patient ◽  
Cancer Center ◽  
P Value ◽  
Cancer Subtype ◽  
Chi Squared ◽  
To Receive ◽  
End Of Life Treatment

e18245 Background: End of life treatment is identified as a high cost low return intervention and is under evaluation as a quality measure for providers. A 2012 ASCO expert panel acknowledged it as the most wasteful practice in oncology. However, characteristics of pts who receive EOLT is poorly described and so interventions to assist providers avoid such treatments are limited. Methods: We identified 299 pts with cancer diagnosis from 2008-2012 and confirmed deceased using our cancer registry. Pts charts were reviewed for last cancer-specific treatments, either chemotherapy (CTX) or radiation therapy (XRT). Characteristics of pts who received treatment within the last 90, 30, and 14 days of life was described. We compared the characteristics of those who received treatment with in the last 14 days of life (here defined as EOLT) to the rest of the population. Chi-squared tests were used to compare between groups. Results: 292 pts (98%) received CTX or XRT within the last 90 days of life, 167 (56%) received treatment within the last 30 days, and 78 (26%) within the last 14 days of life. The main modality of EOLT was CTX (99%). By cancer subtype, up to 50% of gastric and renal cell carcinoma patient received treatment in the last 14 days of life. Older pts, those on clinical trials, and those with longer period of time between diagnosis and death, were less likely to receive EOLT. There is a trend for receipt of EOLT for female pts and those younger than 65 years (p-value 0.059) Conclusions: Our data establishes that more than 25% of deceased pts received treatment in the last 14 days of life. Certain characteristics may influence providers to be aggressive and to deliver care when it is futile. Research to risk stratify pts who are good candidates for treatment is necessary and can improve the value of care delivered to these subjects.

Quality of end-of-life care for veterans with metastatic cancer and advanced chronic kidney disease.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18281-e18281
Author(s):  
Shakira Jeanene Grant ◽  
Claire A Richards ◽  
Nicholas Burwick ◽  
Paul L Hebert ◽  
Ann A O'Hare
Keyword(s):  
Chronic Kidney Disease ◽  
End Of Life ◽  
End Of Life Care ◽  
Metastatic Cancer ◽  
Veterans Affairs ◽  
Life Care ◽  
Advanced Chronic Kidney Disease ◽  
Bereaved Family ◽  
To Receive

e18281 Background: Patients with cancer receive less aggressive interventions and higher quality end-of-life care than those with advanced chronic kidney disease (ACKD). However, the relationship between ACKD and cancer and patterns and quality of end-of-life care is poorly understood. Methods: Among a retrospective cohort of all patients with ACKD (estimated glomerular filtration rate < 20 mL/min/1.73m2) who died in Veterans Affairs facilities between 2009-2015 ( N = 9993), we compared dialysis treatment patterns, end-of-life care and family rated quality of care among those who did and did not have a diagnosis of metastatic cancer during the year before death. Data sources included Veterans Affairs clinical and administrative data, Medicare claims, and the United States Renal Data System registry. Family ratings of end-of-life care were based on responses to the Bereaved Family Survey (BFS). We fit logistic regression models and converted the coefficients to predicted probabilities Results: Overall, 1,237(12.4%) patients had a diagnostic code for metastatic cancer during the year before death. These patients were less likely than other patients to have been treated with dialysis before death. In analyses adjusted for patient characteristics and dialysis receipt, patients with metastatic cancer were less likely than other patients to receive intensive procedures (predicted probability: 18.2% vs. 36.2%) and to be admitted to the intensive care unit (ICU) within 30 days of death (30.7% vs. 50.1 %), or die in the ICU (16.2% vs. 33%). These patients were also more likely to receive a palliative care consultation within 90 days of death (46.6% vs. 37%) and to have hospice services at the time of death (55.3% vs. 33.4 %). Family-rated overall quality of care was higher for those with metastatic cancer (59.6% vs. 54.1%). Family members of patients with metastatic cancer also provided more favorable ratings for five individual BFS items including provider listening, informational, emotional support before death and pain control. All comparisons were statistically significant (i.e., P < 0.05). Conclusions: Within a national cohort of US Veterans with ACKD, the presence of metastatic cancer was associated with less dialysis utilization, less intensive medical care, and significantly higher bereaved family ratings of end-of-life care.

Sign in / Sign up

Export Citation Format

Share Document