scholarly journals Palliative care and end-of-life health care utilization in elderly patients with pancreatic cancer

2018 ◽  
Vol 9 (3) ◽  
pp. 495-502 ◽  
Author(s):  
Nizar Bhulani ◽  
Arjun Gupta ◽  
Ang Gao ◽  
Jenny Li ◽  
Chad Guenther ◽  
...  
Keyword(s):  
Health Care ◽  
Pancreatic Cancer ◽  
Palliative Care ◽  
Elderly Patients ◽  
Health Care Utilization ◽  
End Of Life ◽  
Care Utilization

Palliative care and end-of-life health utilization in elder patients with pancreatic cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 488-488
Author(s):  
Nizar Bhulani ◽  
Ang Gao ◽  
Arjun Gupta ◽  
Jenny Jing Li ◽  
Chad Guenther ◽  
...  
Keyword(s):  
Health Care ◽  
Pancreatic Cancer ◽  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Cancer Patients ◽  
Cost Of Care ◽  
Care Utilization

488 Background: Prospective trials have shown that palliative care is associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients. Methods: Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room and Intensive Care utilization and costs in the last 30 days of life were assessed. Statistical analyses were performed with SAS version 9.4 (SAS Institute, Inc., Cary, NC). Results: Of the 72205 patients with pancreatic cancer, 3383 (4.1%) received palliative care. The proportion of patients receiving palliative care increased from 1.8% in 2000 to 7.8% in 2009 (p for trend < 0.001). Patients with palliative care were more likely to be Asian and women. Of those who received palliative care, 73% received it in the last 30 days of life, and only 11% at least 12 weeks before death. The average number of visits to the ED in the last 30 days of life were significantly higher for patients who received palliative care (0.93±0.62) versus those who did not (0.79±0.61), p < 0.001, and had a significantly higher cost of care ($1317 vs $842, p < 0.001). Intensive care unit length of stay in the last 30 days of life did not differ between patients who did and did not receive palliative care (1.14 days vs 1.04 days, p 0.08). Intensive care unit cost of care was significantly higher for patients with palliative care compared to their counterparts ($5202.641 vs $3896.750, p < 0.001). Conclusions: Palliative care use for pancreatic cancer patients has increased between 2000 and 2009 in this study of Medicare patients. However, it was largely offered close to the end of life and was not associated with reduced health care utilization or cost. Early palliative care referral may be more beneficial.

Palliative care and end-of-life health care utilization of pancreatic cancer patients at an urban safety-net hospital.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 489-489
Author(s):  
Nizar Bhulani ◽  
M. Elizabeth Paulk ◽  
Arjun Gupta ◽  
Kiauna Donnell ◽  
Valorie Harvey ◽  
...  
Keyword(s):  
Health Care ◽  
Pancreatic Cancer ◽  
Palliative Care ◽  
Intensive Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Cancer Patients ◽  
Safety Net ◽  
Care Utilization ◽  
Safety Net Hospital

489 Background: There has been an increase in Palliative care utilization in cancer patients. We examined trends of palliative care and intensive care utilization in pancreatic cancer patients in an urban setting safety net hospital. Methods: This is a retrospective analysis of pancreatic cancer patients seen at the Parkland Health and Hospital System between January 1999 and September 2016. Cancer cases and receipt of palliative care were identified from prospectively maintained registries. Health care utilization including intensive care unit (ICU) was reviewed. All statistical analysis was done using IBM SPSS version 24. Results: We identified 455 new diagnoses of pancreatic cancer, mean age 61 years, 227 (50%) female and 228 (50%) white. Of these, 277 (61%) received palliative care ever. Patient who received palliative care were more likely to be younger (mean age, 59.3+-12 vs 62.8 +- 12 years) and have stage 4 disease vs stage 1-3 disease (p 0.006, and p 0.003 respectively). There was no statistically significant difference in palliative care utilization between gender and ethnicity groups. 140 patients had a DNR order and 29 required ICU admission at any point. A first contact with palliative care consult was obtained < = 7 days before death for 29 (10%) patients, < = 30 days before death for 86 (31%) patients, 30-60 days before death for 50 (18%) and more than 60 days before death for 141 (51%) patients. Patients receiving palliative care were more likely to have a DNR status (p < 0.001) but had no difference in ICU use within the last 30 days of life (p 0.285). Conclusions: The rate of palliative care in patients with pancreatic cancer in this cohort from a safety net hospital is higher than nationally reported studies. Most patients received palliative care > 30 days before death. While patients received early palliative care, it did not result in reduced ICU care. Factors influencing ICU care utilization near the end of life need further study.

scholarly journals Quasi-Experimental Evaluation of LifeCourse on Utilization and Patient and Caregiver Quality of Life and Experience

2018 ◽  
Vol 36 (5) ◽  
pp. 408-416
Author(s):  
Heather R. Britt ◽  
Meghan M. JaKa ◽  
Karl M. Fernstrom ◽  
Paige E. Bingham ◽  
Anne E. Betzner ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Palliative Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Care Utilization ◽  
Serious Illness ◽  
Care Experience ◽  
Quasi Experimental

Whole-person care is a new paradigm for serious illness, but few programs have been robustly studied. We sought to test the effect of LifeCourse (LC), a person-centered program for patients living with serious illness, on health-care utilization, care experience, and quality of life, employing a quasi-experimental design with a Usual Care (UC) comparison group. The study was conducted 2012 to 2017 at an upper-Midwest not-for-profit health-care system with outcomes measured every 3 months until the end of life. Enrolled patients (N = 903) were estimated to be within 3 years of end of life and diagnosed with 1+ serious illness. Exclusion criteria included hospice enrollment at time of screening or active dying. Community health workers (CHWs) delivered standardized monthly 1-hour home visits based on palliative care guidelines and motivational interviewing to promote patients’ physical, psychosocial, and financial well-being. Primary outcomes included health-care utilization and patient- and caregiver-experience and quality of life. Patients were elderly (LC 74, UC 78 years) and primarily non-Hispanic, white, living at home with cardiovascular disease as the primary diagnosis (LC 69%, UC 57%). A higher proportion of LC patients completed advance directives (N = 173, 38%) than UC patients (N = 66, 15%; P < .001). LifeCourse patients who died spent more days in hospice (88 ± 191 days) compared to UC patients (44 ± 71 days; P = .018). LifeCourse patients reported greater improvements than UC in communication as part of the care experience ( P = .016). Implementation of person-centered programs delivered by CHWs is feasible; inexpensive upstream expansion of palliative care models can yield benefits for patients and caregivers. Trial Registration: Trial NCT01746446 was registered on November 27, 2012 at ClinicalTrials.gov .

scholarly journals Palliative Care and Health Care Utilization for Patients With End-Stage Liver Disease at the End of Life

2017 ◽  
Vol 15 (10) ◽  
pp. 1612-1619.e4 ◽  
Author(s):  
Arpan A. Patel ◽  
Anne M. Walling ◽  
Joni Ricks-Oddie ◽  
Folasade P. May ◽  
Sammy Saab ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Liver Disease ◽  
Health Care Utilization ◽  
End Of Life ◽  
Care Utilization ◽  
End Stage Liver Disease ◽  
End Stage

scholarly journals Association of Palliative Care Use and Setting With Health-care Utilization and Quality of Care at the End of Life Among Patients With Advanced Lung Cancer

CHEST Journal ◽  
2020 ◽  
Vol 158 (6) ◽  
pp. 2667-2674 ◽  
Author(s):  
Kelly C. Vranas ◽  
Jodi A. Lapidus ◽  
Linda Ganzini ◽  
Christopher G. Slatore ◽  
Donald R. Sullivan
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Palliative Care ◽  
Quality Of Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Advanced Lung Cancer ◽  
Care Utilization

scholarly journals Health care utilization at end of life among patients with lung or pancreatic cancer. Comparison between two Swedish cohorts

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254673
Author(s):  
Helena Ullgren ◽  
Per Fransson ◽  
Anna Olofsson ◽  
Ralf Segersvärd ◽  
Lena Sharp
Keyword(s):  
Health Care ◽  
Pancreatic Cancer ◽  
Health Care Utilization ◽  
End Of Life ◽  
Acute Care ◽  
Care Utilization ◽  
Intensity Of Care ◽  
Ed Visits ◽  
Secondary Outcomes ◽  
The Difference

Objectives The purpose was to analyze trends in intensity of care at End-of-life (EOL), in two cohorts of patients with lung or pancreatic cancer. Setting We used population-based registry data on health care utilization to describe proportions and intensity of care at EOL comparing the two cohorts (deceased in the years of 2010 and 2017 respectively) in the region of Stockholm, Sweden. Primary and secondary outcomes Main outcomes were intensity of care during the last 30 days of life; systemic anticancer treatment (SACT), emergency department (ED) visits, length of stay (LOS) > 14 days, intensive care (ICU), death at acute care hospital and lack of referral to specialized palliative care (SPC) at home. The secondary outcomes were outpatient visits, place of death and hospitalizations, as well as radiotherapy and major surgery. A multivariable logistic regression analysis was used for associations. A moderation variable was added to assess for the effect of SPC at home between the cohorts. Results Intensity of care at EOL increased over time between the cohorts, especially use of SACT, increased with 10%, p<0.001, (n = 102/754 = 14% to n = 236/972 = 24%), ED visits with 7%, p<0.001, (n = 25/754 = 3% to n = 100/972 = 10%) and ICU care, 2%, p = 0.04, (n = 12/754 = 2% to n = 38/972 = 4%). High intensity of care at EOL were more likely among patients with lung cancer. The difference in use of SACT between the years, was moderated by SPC, with an increase of SACT, unstandardized coefficient β; 0.87, SE = 0.27, p = 0.001, as well as the difference between the years in death at acute care hospitals, that decreased (β = 0.69, SE = 0.26, p = 0.007). Conclusion These findings underscore an increase of several aspects regarding intensity of care at EOL, and a need for further exploration of the optimal organization of EOL care. Our results indicate fragmentation of care and a need to better organize and coordinate care for vulnerable patients.

Health Care Utilization and End of Life Care for Older Patients with Acute Myeloid Leukemia Receiving Supportive Care Alone

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2126-2126
Author(s):  
Areej El-Jawahri ◽  
Sean F. Heavey ◽  
Thomas W. LeBlanc ◽  
Harry Vandusen ◽  
Gregory Abel ◽  
...  
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Palliative Care ◽  
Health Care Utilization ◽  
Supportive Care ◽  
End Of Life ◽  
Older Patients ◽  
Research Funding ◽  
Advisory Board ◽  
Care Utilization

Abstract Introduction: Many older adults (≥ 60) with AML treated with intensive or non-intensive chemotherapy have a poor prognosis and spend a significant portion of their life from diagnosis until death in the hospital. We hypothesized that the burden of illness, rather than its treatment, plays a major role in increasing health care utilization. Therefore, we examined health care utilization and end-of-life (EOL) outcomes for older adults with AML receiving supportive care alone. Methods: We conducted a retrospective analysis of 98 consecutive older patients diagnosed with AML between 9/9/1993 and 12/23/2011 and treated with supportive care alone at two tertiary care hospitals. We examined their health care utilization including frequency of hospitalizations, clinic visits, and intensive care unit admissions and their place of death. We also assessed health care utilization during the last 30 days of life including palliative care consultations, hospice referrals, hospitalizations, and blood transfusions. Results: The study included mostly white (n= 93/98, 95%) and male (n=52/98, 53%) patients with a median age of 77 (range 60-94). Supportive care treatments included transfusions (n=59/98, 60%), hydroxurea and transfusions (n=23/98, 24%), hydroxyurea without transfusion support (n=9/98, 9%), transfusions and growth factor support (n=7/98, 7%), or growth factor support alone (n=1/98, 1%). The median number of hospitalizations for the entire cohort was 1 (range 0-5). All patients died with a median number of days from diagnosis until death of 36.0 days (range 1-389). Patients spent a mean of 36% of their life from diagnosis in the hospital and 8% of their life attending outpatient clinic appointments. Only 18% (n=18/98) and 30% (n=29/98) of patients utilized palliative care or hospice services, respectively. A minority of patients (n=13/98, 13%) were admitted to the intensive care unit with 11% (n=11/98) having an intensive care unit stay during the last 30 days of life. Within 30 days of death, 88% (n=87/98) of patients were hospitalized with 46% (N=45/98) dying in the hospital. The majority (n=89/98, 92%) of patients received a blood transfusion within the last 30 days of life and 64% (n=58/91) received a transfusion in the last 7 days of life. Conclusion: Despite a decision to not receive chemotherapy, older patients with AML receiving supportive care alone have high health care utilization reflecting the burden of this disease. Despite this populations' poor prognosis, palliative care and hospice services are rarely utilized. Future work should study novel health-care delivery models designed to meet the needs of this population, such as transfusion support and other intensive supportive care measures at home toward the EOL. Figure 1. Proportion of life spent in hospital, clinic, or home Figure 1. Proportion of life spent in hospital, clinic, or home Figure 2. Health Care Utilization near the end of life Figure 2. Health Care Utilization near the end of life Figure 3. Place of death Figure 3. Place of death Disclosures LeBlanc: Boehringer Ingelheim: Membership on an entity's Board of Directors or advisory committees; Flatiron: Consultancy; Epi-Q: Consultancy; Helsinn Therapeutics: Honoraria, Research Funding. Steensma:Incyte: Consultancy; Amgen: Consultancy; Celgene: Consultancy; Onconova: Consultancy. Fathi:Seattle Genetics: Other: Advisory Board participation, Research Funding; Agios Pharmaceuticals: Other: Advisory Board participation; Merck: Other: Advisory Board participation. DeAngelo:Celgene: Consultancy; Amgen: Consultancy; Ariad: Consultancy; Bristol Myers Squibb: Consultancy; Agios: Consultancy; Incyte: Consultancy; Novartis: Consultancy; Pfizer: Consultancy. Stone:Merck: Consultancy; Agios: Consultancy; AROG: Consultancy; Roche/Genetech: Consultancy; Pfizer: Consultancy; Karyopharm: Consultancy; Sunesis: Consultancy, Other: DSMB for clinical trial; Abbvie: Consultancy; Celator: Consultancy; Amgen: Consultancy; Celgene: Consultancy; Novartis: Research Funding; Juno: Consultancy. Chen:Bayer: Consultancy, Research Funding.

Trends in Health-Care Utilization at the End of Life Among Patients With Hematologic Malignancies in a Middle-Income Country: Challenges and Opportunities in Brazil

2019 ◽  
Vol 36 (9) ◽  
pp. 775-779 ◽  
Author(s):  
Luiz Guilherme L. Soares ◽  
Renato Vieira Gomes ◽  
André M. Japiassu
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
End Of Life Care ◽  
Hematologic Malignancies ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Blood Transfusions ◽  
Life Care ◽  
To Receive

Patients with hematologic malignancies (HMs) often receive poor-quality end-of-life care. This study aimed to identify trends in end-of-life care among patients with HM in Brazil. We conducted a retrospective cohort study (2015-2018) of patients who died with HM, using electronic medical records linked to health insurance databank, to evaluate outcomes consistent with health-care resource utilization at the end of life. Among 111 patients with HM, in the last 30 days of life, we found high rates of emergency department visits (67%, n = 75), intensive care unit admissions (56%, n = 62), acute renal replacement therapy (10%, n = 11), blood transfusions (45%, n = 50), and medical imaging utilization (59%, n = 66). Patients received an average of 13 days of inpatient care and the majority of them died in the hospital (53%, n = 58). We also found that almost 40% of patients (38%, n = 42) used chemotherapy in the last 14 days of life. These patients were more likely to be male (64% vs 22%; P < .001), to receive blood transfusions (57% vs 38%; P = .05), and to die in the hospital (76% vs 39%; P = .009) than patients who did not use chemotherapy in the last 14 days of life. This study suggests that patients with HM have high rates of health-care utilization at the end of life in Brazil. Patients who used chemotherapy in the last 14 days of life were more likely to receive blood transfusions and to die in the hospital.

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