Days at Home in the Last 6 Months of Life: A Patient-Determined Quality Indicator for Cancer Care

PURPOSE: Quality end-of-life care (EoLC) is a key aspect of oncology. Days at home in the last 6 months of life represents a novel, patient-driven quality indicator of EoLC. We measured days at home in a large population of patients with cancer in Ontario, Canada. Trends over time and predictors of more or less time at home were also determined. METHODS: We conducted a population-based retrospective study using health administrative data linked by unique, encoded identifiers and analyzed at the ICES. Quantile regression was used to determine significant predictors of more or less time at home. RESULTS: Of 72,987 patients who died of cancer in Ontario, Canada and met our inclusion criteria, the median number of days spent at home in the last 6 months of life was 164 (interquartile range [IQR], 144 to 175 days) of a possible 180 days. Patients with hematologic cancers spent significantly fewer days at home (156; IQR, 134 to 170 days). The strongest predictors of more time at home were male sex (+2.87 days relative to female sex; CI, 2.43 to 3.31 days) and receipt of palliative care before the last 6 months of life (+2.38 days; CI, 1.95 to 2.08 days). Additional predictors included income, age, cancer type, comorbidity burden, and health region. The majority of patients (69.7%) did not die at home. CONCLUSION: Days at home in the last 6 months of life, obtained from administrative data, can be used as a measure of quality EoLC. Predictors of days at home may prove valuable targets for future policy intervention.

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Care consumption of people with multiple sclerosis: A multichannel sequence analysis in a population-based setting in British Columbia, Canada

Multiple Sclerosis Journal ◽

10.1177/13524585211016726 ◽

2021 ◽

pp. 135245852110167

Author(s):

Jonathan Roux ◽

Elaine Kingwell ◽

Feng Zhu ◽

Helen Tremlett ◽

Emmanuelle Leray ◽

...

Keyword(s):

Multiple Sclerosis ◽

British Columbia ◽

Sequence Analysis ◽

Multidisciplinary Care ◽

Median Number ◽

Population Based ◽

Service Planning ◽

Physician Visits ◽

Comorbidity Burden ◽

Incident Cohort

Background: Persons with multiple sclerosis (PwMS) typically require complex multidisciplinary care, which is rarely formally assessed. Objectives: We applied multichannel sequence analysis (MCSA) to identify care consumption patterns by PwMS in British Columbia, Canada. Methods: We created two cohorts, comprising incident and prevalent MS cases, using linked clinical and administrative data. We applied MCSA to quantify and compare the care pathways of PwMS, based on all-cause hospitalizations and physician visits (divided into five specialities). Care consumption clusters were characterized using demographic and clinical features. Results: From 1048 incident and 3180 prevalent PwMS, the MCSA identified 12 and 6 distinct care consumption clusters over a median follow-up of 9.6 and 13.0 years, respectively. Large disparities between clusters were observed; the median number of annual consultations ranged from 5.6 to 21.3 for general practitioners, 1.2 to 4.6 for neurologists and 0 to 5.3 for psychiatrists in the incident cohort. Characteristics at MS symptom onset associated with the highest care consumption included high comorbidity burden and older age. There were similar disparities and associations for prevalent PwMS. Conclusion: The distinct patterns of care consumption, which were reminiscent of the heterogeneity of MS itself, may facilitate health service planning and evaluation, and provide a novel outcome measure in health research.

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Where Patients With Cancer Die: A Population-Based Study, 1990 to 2012

Journal of Palliative Care ◽

10.1177/0825859718814813 ◽

2018 ◽

Vol 34 (4) ◽

pp. 224-231 ◽

Cited By ~ 1

Author(s):

Roger W. Hunt ◽

Katina D’Onise ◽

Anh-Minh Thi Nguyen ◽

Kamalesh Venugopal

Keyword(s):

Palliative Care ◽

Nursing Homes ◽

Care Delivery ◽

Young Patients ◽

Population Based ◽

Place Of Death ◽

Patients With Cancer ◽

Metropolitan Hospital ◽

Care Models ◽

At Home

Aims:To describe changes in the place of death of patients with cancer from 1990 to 2012, and to identify issues for their end-of-life care.Materials and Methods:Population-based descriptive study, with analyses of place of death patterns, using the South Australian Cancer Registry records of 86 257 patients with cancer who died from 1990 to 2012.Results:From 1990 to 2012, the proportion of cancer deaths in hospital decreased from 63.4% to 50.9%, and in nursing homes increased from 8.2% to 22.5%. After the year 2000, the proportions in hospices and at home were both below 15%. Multivariate analyses showed that young patients with cancer were more likely to die in a hospice or at home, compared to elderly patients with cancer who were more likely to die in a nursing home; the likelihood of dying in a hospice increased with socioeconomic status; patients with a short survival time or a hematological malignancy were more likely to die in a metropolitan hospital.Conclusions:Compared to most other countries, the proportion of cancer deaths at home was low, and many patients would not have died at their preferred place. The trend for more cancer deaths to occur in nursing homes is likely to continue, but nursing homes generally lack the resources and skilled staff to provide quality palliative care. Models of palliative care delivery should take account of patient preferences, the growth of terminal cancer care in nursing homes, and apparent inequities.

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Predictors of venous thromboembolism recurrence and bleeding among active cancer patients: a population-based cohort study

Blood ◽

10.1182/blood-2014-01-549733 ◽

2014 ◽

Vol 123 (25) ◽

pp. 3972-3978 ◽

Cited By ~ 100

Author(s):

Cheng E. Chee ◽

Aneel A. Ashrani ◽

Randolph S. Marks ◽

Tanya M. Petterson ◽

Kent R. Bailey ◽

...

Keyword(s):

Cohort Study ◽

Venous Thromboembolism ◽

Recurrence Risk ◽

Population Based ◽

Secondary Prophylaxis ◽

Cancer Type ◽

Patients With Cancer ◽

Key Points ◽

Venous Thromboembolism Recurrence ◽

Active Cancer

Key Points VTE recurrence risk in patients with cancer can be stratified by cancer type, stage, stage progression, and presence of leg paresis. Patients with cancer at high VTE recurrence risk should be considered for secondary prophylaxis.

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Extent of lymphadenectomy and survival in stomach cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.17008 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 17008-17008

Author(s):

S. L. Wong ◽

H. Ji ◽

J. D. Birkmeyer

Keyword(s):

Lymph Node ◽

Stomach Cancer ◽

Quality Indicator ◽

Survival Rates ◽

Median Number ◽

Population Based ◽

Extensive Lymphadenectomy ◽

Provider Characteristics ◽

Risk Patients ◽

Total Lymph Node

17008 Background: Based on population-based studies, some investigators have posited that patients undergoing more extensive lymphadenectomy as part of their resection for stomach cancer had improved late survival rates. Such findings have prompted calls for the use of total lymph node counts as a quality indicator for hospitals. However, apparent relationships between number of lymph nodes resected and survival may be confounded by patient selection bias and provider factors. It is not clear that hospitals with higher lymph node counts have better outcomes than other hospitals. The purpose of this study is to examine relationships between total lymph node counts and survival for stomach cancer. Methods: Using the national Surveillance Epidemiology and End Results (SEER)-Medicare linked database (1992–2002), we first identified all patients undergoing major resections for gastric cancer (n=3,049). Hospitals at which the procedures were performed were categorized into 3 groups (terciles) according to the median number of nodes examined. We then assessed 5-year survival rates for each hospital group, adjusting for potentially confounding patient and hospital characteristics. Results: Hospitals with the highest median lymph node counts had slightly higher 5-year survival rates than those with the lowest node counts (31% vs. 28%; unadjusted HR for mortality 0.90, 95% CI 0.81–1.00). Hospitals with higher lymph node counts tended to treat lower risk patients and had lower procedure volumes. Adjusting for these confounding patient and provider characteristics further weakened the apparent relationship between survival and lymph node counts by hospital (adjusted HR, high vs. low hospital tercile, 0.96; 95% CI 0.85–1.09). Conclusions: Apparent relationships between total lymph node counts by hospital and 5-year survival rates after resection for stomach cancer are relatively weak and explained in large part by confounding patient and provider factors. Stronger evidence should be required before moving forward with this metric as a hospital quality indicator. No significant financial relationships to disclose.

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Short- and long-term outcomes of infective endocarditis admission in adults: A population-based registry study in Finland

PLoS ONE ◽

10.1371/journal.pone.0254553 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254553

Author(s):

Elina Ahtela ◽

Jarmo Oksi ◽

Tero Vahlberg ◽

Jussi Sipilä ◽

Päivi Rautava ◽

...

Keyword(s):

Infective Endocarditis ◽

Large Population ◽

Temporal Trends ◽

Population Based ◽

Factors Affecting ◽

Comorbidity Burden ◽

Hospital Stays ◽

Population Based Registry ◽

Long Term Mortality

Infective endocarditis (IE) is associated with high mortality. However, data on factors associated with length of stay (LOS) in hospital due to IE are scarce. In addition, long-term mortality of more than 1 year is inadequately known. In this large population-based study we investigated age and sex differences, temporal trends, and factors affecting the LOS in patients with IE and in-hospital, 1-year, 5-year and 10-year mortality of IE. Data on patients (≥18 years of age) admitted to hospital due to IE in Finland during 2005–2014 were collected retrospectively from nationwide obligatory registries. We included 2166 patients in our study. Of the patients 67.8% were men. Women were older than men (mean age 63.3 vs. 59.5, p<0.001). The median LOS was 20.0 days in men and 18.0 in women, p = 0.015. In the youngest patients (18–39 years) the median LOS was significantly longer than in the oldest patients (≥80 years) (24.0 vs. 16.0 days, p = 0.014). In-hospital mortality was 10% with no difference between men and women. Mortality was 22.7% at 1 year whereas 5- and 10-year mortality was 37.5% and 48.5%, respectively. The 5-year and 10-year mortality was higher in women (HR 1.18, p = 0.034; HR 1.18, p = 0.021). Both in-hospital and long-term mortality increased significantly with aging and comorbidity burden. Both mortality and LOS remained stable over the study period. In conclusion, men had longer hospital stays due to IE compared to women. The 5- and 10-year mortality was higher in women. The mortality of IE or LOS did not change over time.

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Validation Study for the Brief Measure of Quality of Life and Quality of Care: A Questionnaire for the National Random Sampling Hospital Survey

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909117693576 ◽

2017 ◽

Vol 34 (7) ◽

pp. 622-631 ◽

Cited By ~ 1

Author(s):

Megumi Shimizu ◽

Daisuke Fujisawa ◽

Miho Kurihara ◽

Kazuki Sato ◽

Tatsuya Morita ◽

...

Keyword(s):

Quality Of Life ◽

Quality Of Care ◽

Large Population ◽

Population Based ◽

Physical Symptoms ◽

Care Staff ◽

Health Care Staff ◽

Validity And Reliability ◽

Patients With Cancer

Background: To monitor quality of life (QOL) for patients with cancer in a large population-based survey, we developed a short QOL and quality-of-care (QOC) questionnaire. To determine the validity and reliability of this new questionnaire for evaluating QOL in patients with cancer. Methods: Outpatients and inpatients at National Cancer Center Hospital East were administered a questionnaire, including the following items—the short QOL and QOC questionnaire (physical distress, pain, emotional distress, walk burden, and need for help with self-care; perceived general health status; and satisfaction with medical care and treatment by doctor, communication with doctor, support by health-care staff other than doctor, care for physical symptoms such as pain, and psychological care), the Functional Assessment of Cancer Therapy—General (FACT-G), the Cancer Care Evaluation Scale (CCES) for patients, and demographic and medical data. We then readministered the short QOL and QOC questionnaire. Results: In total, 329 outpatients and 239 inpatients completed the survey (response rates: 80% and 90%, respectively). Total Cronbach α for the short QOL and QOC questionnaire was 0.83 for outpatients and 0.82 for inpatients. Items of the questionnaire correlated with cancer-specific measurements, FACT-G, and CCES. Intraclass correlation coefficients for all items of the questionnaire were 0.79 and 0.89 in each setting. Items of QOL and QOC did not correlate with each other. Conclusion: The validity and reliability of the short QOL and QOC questionnaire appear sufficient. This questionnaire enables continuous monitoring of patient QOL in large population-based surveys.

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High prevalence of pain in patients with cancer in a large population-based study in The Netherlands

Pain ◽

10.1016/j.pain.2007.08.022 ◽

2007 ◽

Vol 132 (3) ◽

pp. 312-320 ◽

Cited By ~ 158

Author(s):

Marieke H.J. van den Beuken-van Everdingen ◽

Janneke M. de Rijke ◽

Alfons G. Kessels ◽

Harry C. Schouten ◽

Maarten van Kleef ◽

...

Keyword(s):

The Netherlands ◽

Large Population ◽

Population Based ◽

Population Based Study ◽

Patients With Cancer ◽

High Prevalence ◽

Prevalence Of Pain

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Increased Prevalence of Prior Malignancies and Autoimmune Diseases in Patients Diagnosed with Chronic Myeloid Leukemia

Blood ◽

10.1182/blood.v126.23.1586.1586 ◽

2015 ◽

Vol 126 (23) ◽

pp. 1586-1586

Author(s):

Niklas Gunnarsson ◽

Martin Hoglund ◽

Leif Stenke ◽

Solveig Wallberg Jonsson ◽

Fredrik Sandin ◽

...

Keyword(s):

Urinary Tract ◽

Chronic Myeloid Leukemia ◽

Myeloid Leukemia ◽

Large Population ◽

Population Based ◽

Endocrine Gland ◽

Cancer Type ◽

Odds Ratios ◽

Detection Bias ◽

Increased Risk

Abstract Background: In a recent, large population-based study we identified an increased risk of a second malignancy in patients following a diagnosis of Chronic Myeloid Leukemia (CML), as compared to an age- and gender-matched control cohort (Gunnarsson et al, Br J Haematol. 2015 Jun; 169(5): 683-8). If CML patients have an increased congenital or acquired susceptibility to develop any cancer, the prevalence of other prior malignancies would be expected to be increased already at the time of CML diagnosis. There is a known association between autoimmune disease (AD) or chronic inflammatory disease (CID) and the development of some hematological malignancies. However, to date, studies on the prevalence of AD or CID detected prior to the CML diagnosis are few and inconclusive. Our aim was to estimate the prevalence of other malignancies, AD or CID in CML patients at or before the time point of the CML diagnosis. Materials and methods: We used the population-based Swedish CML Register to identify patients diagnosed with CML in Sweden between 2002-2013. This cohort was linked to the Swedish Cancer Register to retrieve information about malignancies reported before the diagnosis of CML and the Swedish National Patient Register to retrieve information about AD and CID. For each of the 984 patients with CML, five age-, gender- and county of residence-matched controls were selected from the general population. All controls had to be free of CML and alive at the time of CML diagnosis for the corresponding case patient. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI). We excluded diagnoses registered during the year prior to the CML diagnosis to avoid detection bias. In separate steps, analyses were also performed based on diagnoses of AD, CID or cancer three years before the date of CML diagnosis. Results: A total of 984 CML patients were assessed with regard to a prior diagnosis of malignancy, AD or CID excluding the year immediately prior to their CML diagnosis, representing more than 45.000 person-years of follow-up. Compared to the matched population controls, the prevalence of prior malignancies and AD were elevated in CML patients: OR 1.47 (95%CI 1.20-1.82) and 1.55 (1.21-1.98), respectively. Breast-, gastrointestinal- and urinary tract cancers and melanomas were common cancer types and were all significantly more prevalent in the CML cohort, table I. After implementing a three-year exclusion period before the date of CML diagnosis, prior malignancies remained more prevalent in CML patients. Assessment of ADs was hampered by small numbers, sarcoidosis was the only AD with increased prevalence: OR 13.43; 95 % CI 3.56 - 50.73. No association was detected between CML and previous CID. Conclusions: Based on a large population-based cohort, our findings indicate that CML patients have an increased prevalence of other malignancies and AD prior to the diagnosis of CML, suggesting that a hereditary or acquired predisposition to cancer and/or autoimmunity is involved in the pathogenesis of CML. Table 1. Odds Ratios for malignancies prior to CML among 984 Swedish CML patients diagnosed between 2002 and 2013. Diagnoses of malignancy during the year immediately prior to CML diagnosis excluded to avoid detection bias. Participants Latency More Than 3 YearsBefore CML Diagnosis Variable CMLn=984 Controlsn = 4920 OR 95% CI CMLn=984 Controlsn = 4920 OR 95% CI Overall 128 453 1.47 1.20 - 1.82 113 381 1.55 1.24 - 1.93 Men 58 184 1.61 1.19 - 2.18 50 146 1.75 1.26 - 2.43 Women 70 269 1.32 1.01 - 1.74 63 235 1.36 1.02 - 1.82 Age <60 years 66 221 1.53 1.15 - 2.03 60 209 1.46 1.09 - 1.97 Age ≥ 60 years 62 232 1.36 1.02 - 1.81 53 172 1.57 1.15 - 2.16 Second cancer type Gastrointestinal 21 62 1.71 1.04 - 2.82 19 50 1.92 1.13 - 3.27 Breast 32 88 1.85 1.22 - 2.78 24 65 1.87 1.16 - 3.00 Gynecological 28 132 1.06 0.70 - 1.61 25 130 0.96 0.62 - 1.48 Ear-nose-throat 1 12 0.42 0.05 - 3.20 1 6 0.83 0.10 - 6.93 Endocrine Gland 9 13 3.48 1.49 - 8.17 7 11 3.20 1.24 - 8.27 Lung 1 7 0.71 0.09 - 5.81 1 4 1.25 0.14 - 11.20 Urinary tract 14 37 1.90 1.03 - 3.54 11 29 1.91 0.95 - 3.83 Malignant melanoma 13 32 2.05 1.07 - 3.91 12 21 2.88 1.41 - 5.87 Prostate 20 84 1.19 0.73 - 1.95 18 64 1.41 0.83 - 2.40 Non-Hodgkin Lymphoma 1 7 0.71 0.09 - 5.81 1 4 1.25 0.14 - 11.20 Chronic Lymphatic Leukemia 3 2 7.52 1.25 - 45.06 1 1 5.00 0.31 - 80.07 Polycythemia Vera 1 3 1.67 0.17 - 16.05 1 2 2.50 0.23 - 27.62 Central Nervous System 3 10 1.50 0.41 - 5.47 3 9 1.67 0.45 - 6.18 Testicle 2 3 3.34 0.56 - 20.00 2 2 5.01 0.70 - 35.60 Disclosures Richter: Ariad: Honoraria; Bristol-Myers Squibb: Honoraria; Novartis: Honoraria. Sjalander:Novartis: Honoraria.

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Association between Moving to a High-Volume Hospital in the Capital Area and the Mortality among Patients with Cancer: A Large Population-Based Cohort Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18073812 ◽

2021 ◽

Vol 18 (7) ◽

pp. 3812

Author(s):

Jung-kyu Choi ◽

Se-Hyung Kim ◽

Myung-Bae Park

Keyword(s):

Low Income ◽

Large Population ◽

High Volume ◽

Healthcare Services ◽

Population Based ◽

Patients With Cancer ◽

Final Sample ◽

High Volume Hospital ◽

Study Population ◽

Low Income Families

This study aimed to identify the association between moving to a high-volume hospital and the mortality of patients with cancer living in the district. The study population comprised participants diagnosed with cancer within the past nine years (2004–2012). The final sample included 8197 patients with cancer, 3939 were males (48.1%), and 4258 were females (51.9%). A Cox proportional hazard model was used to estimate the hazard ratio (HR) for death. Confounding variables including sex, age, type of social security, income level, disability, and utilization volume were incorporated into the model. Among patients with cancer living in the district, 2874 (35.1%) used healthcare services in Seoul. About 10% (n = 834) of patients died during the follow-up period. The HR for death in females (HR: 0.68, 95% CI: 0.58–0.81) was lower than that in males. Additionally, the HR for the death of patients using healthcare services in Seoul (HR: 1.30, 95% CI: 1.11–1.53) was higher than those patients who did not use healthcare services in Seoul. Among patients utilizing services in the province, wealthier patients’ survival probability was significantly higher than that of others. The cause of income differences should be identified, and accessibility to medical use of low-income families should be enhanced to prevent mortality of patients from cancer disparities.

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Distinctive Cancer Associations in Patients With Neurofibromatosis Type 1

Journal of Clinical Oncology ◽

10.1200/jco.2015.65.3576 ◽

2016 ◽

Vol 34 (17) ◽

pp. 1978-1986 ◽

Cited By ~ 109

Author(s):

Elina Uusitalo ◽

Matti Rantanen ◽

Roope A. Kallionpää ◽

Minna Pöyhönen ◽

Jussi Leppävirta ◽

...

Keyword(s):

Breast Cancer ◽

Neurofibromatosis Type 1 ◽

Neurofibromatosis Type ◽

Population Based ◽

Cancer Type ◽

Clinical Practices ◽

Patients With Cancer ◽

Peripheral Nerve Sheath Tumors ◽

Risk Of Cancer

Purpose The current study was designed to determine the risk of cancer in patients with neurofibromatosis type 1 (NF1) by cancer type, age, and sex with unprecedented accuracy to be achieved by combining two total population–based registers. Patients and Methods A population-based series of patients with NF1 (N = 1,404; 19,076 person-years) was linked to incident cancers recorded in the Finnish Cancer Registry and deaths recorded in the national Population Register Centre between 1987 and 2012. Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) were calculated for selected cancer types. Survival of the patients with cancer with and without NF1 was compared. Results In malignant peripheral nerve sheath tumors and CNS tumors, the cancers traditionally associated with NF1, we observed SIRs of 2,056 (95% CI, 1,561 to 2,658), and 37.5 (95% CI, 30.2 to 46.0), respectively, and SMRs of 2,301 (95% CI, 1,652 to 3,122) and 30.2 (95% CI, 19.1 to 45.2), respectively. We found an unequivocally increased risk for breast cancer. In particular, SIR was 11.1 (95% CI, 5.56 to 19.5) for breast cancer in women with NF1 age < 40 years; the overall SMR for breast cancer was 5.20 (95% CI, 2.38 to 9.88). Particularly high overall SIRs were observed in patients with NF1 age < 15 years: women, 87.6 (95% CI, 58.6 to 125); men, 45.6 (95% CI, 28.4 to 68.5). An estimated lifetime cancer risk for patients with NF1 was 59.6%. The 5-year survival of patients with cancer and NF1, excluding nervous tissue cancers, was worse than that of comparable patients with cancers without NF1 (54.0% v 67.5%; P = .01). Conclusion Our results emphasize the general cancer proclivity of patients with NF1. These findings should translate to clinical practices to determine clinical interventions and focused follow-up of patients with NF1.

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