scholarly journals Factors affecting use of unscheduled care for people with advanced cancer: a retrospective cohort study in Scotland

2019 ◽  
Vol 69 (689) ◽  
pp. e860-e868 ◽  
Author(s):  
Sarah Mills ◽  
Deans Buchanan ◽  
Bruce Guthrie ◽  
Peter Donnan ◽  
Blair Smith
Keyword(s):  
Cohort Study ◽  
Advanced Cancer ◽  
Retrospective Cohort Study ◽  
Rural Areas ◽  
Retrospective Cohort ◽  
Descriptive Analysis ◽  
Binary Logistic Regression ◽  
Clinical Population ◽  
Cancer Type ◽  
Unscheduled Care

BackgroundPeople with advanced cancer frequently attend unscheduled care, but little is known about the factors influencing presentations. Most research focuses on accident and emergency (A&E) and does not consider GP out-of-hours (GPOOH).AimTo describe the frequency and patterns of unscheduled care use by people with cancer in their last year of life and to examine the associations of demographic and clinical factors with unscheduled care attendance.Design and settingRetrospective cohort study of all 2443 people who died from cancer in Tayside, Scotland, during 2012–2015. Clinical population datasets were linked to routinely collected clinical data using the Community Health Index (CHI) number.MethodAnonymised CHI-linked data were analysed in SafeHaven, with descriptive analysis, using binary logistic regression for adjusted associations.ResultsOf the people who died from cancer, 77.9% (n = 1904) attended unscheduled care in the year before death. Among unscheduled care users, most only attended GPOOH (n = 1070, 56.2%), with the rest attending A&E only (n = 204, 10.7%), or both (n = 630, 33.1%). Many attendances occurred in the last week (n =1360, 19.7%), last 4 weeks (n = 2541, 36.7%), and last 12 weeks (n = 4174, 60.3%) of life. Age, sex, deprivation, and cancer type were not significantly associated with unscheduled care attendance. People living in rural areas were less likely to attend unscheduled care: adjusted odds ratio (aOR) 0.64 (95% confidence interval = 0.50 to 0.82). Pain was the commonest coded clinical reason for presenting (GPOOH: n = 482, 10.5%; A&E: n = 336, 28.8%). Of people dying from cancer, n = 514, 21.0%, were frequent users (≥5 attendances/year), and accounted for over half (n = 3986, 57.7%) of unscheduled care attendances.ConclusionUnscheduled care attendance by people with advanced cancer was substantially higher than previously reported, increased dramatically towards the end of life, was largely independent of demographic factors and cancer type, and was commonly for pain and palliative care.

scholarly journals Inequity in palliative care service full utilisation among patients with advanced cancer: a retrospective Cohort study

2020 ◽  
Vol 59 (6) ◽  
pp. 620-627
Author(s):  
Daniela D’Angelo ◽  
Marco Di Nitto ◽  
Diana Giannarelli ◽  
Ileana Croci ◽  
Roberto Latina ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Advanced Cancer ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Care Service ◽  
Palliative Care Service

Palliative sedation in patients with advanced cancer in a specialized unit in a middle-income country: A retrospective cohort study

2021 ◽  
pp. 1-5
Author(s):  
Carolina Záu Serpa de Araujo ◽  
Laís Záu Serpa de Araújo ◽  
Antonio Paulo Nassar Junior
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Advanced Cancer ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Palliative Sedation ◽  
Palliative Care Unit ◽  
Middle Income ◽  
Hospital Survival ◽  
Tertiary Teaching

Abstract Objective To describe the 5-year practice on palliative sedation in a specialized palliative care unit in a deprived region in Brazil, and to compare survival of patients with advanced cancer who were and were not sedated during their end-of-life care. Method Retrospective cohort study in a tertiary teaching hospital. We described the practice of palliative sedation and compared the survival time between patients who were and were not sedated in their last days of life. Results We included 906 patients who were admitted to the palliative care unit during the study period, of whom, 92 (10.2%) received palliative sedation. Patients who were sedated were younger, presented with higher rates of delirium, and reported more pain, suffering, and dyspnea than those who were not sedated. Median hospital survival of patients who received palliative sedation was 9.30 (CI 95%, 7.51–11.81) days and of patients who were not sedated was 8.2 (CI 95%, 7.3–9.0) days (P = 0.31). Adjusted for age and sex, palliative sedation was not significantly associated with hospital survival (hazard ratio = 0.93; CI 95%, 0.74–1.15). Significance of results Palliative sedation can be accomplished even in a deprived area. Delirium, dyspnea, and pain were more common in patients who were sedated. Median survival was not reduced in patients who were sedated.

scholarly journals LO026: Outcomes of a provincial cardiac reperfusion strategy: a population-based, retrospective cohort study

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S38-S39
Author(s):  
J. Cook ◽  
A. Carter ◽  
A. Travers ◽  
R. Brown ◽  
E. Cain ◽  
...  
Keyword(s):  
Cohort Study ◽  
Nova Scotia ◽  
Retrospective Cohort Study ◽  
Rural Areas ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Cardiovascular Health ◽  
Coronary Intervention ◽  
Reperfusion Strategy ◽  
The Impact

Introduction: Nova Scotia has a province wide reperfusion strategy for the treatment of patients presenting with acute ST-Elevation Myocardial Infarction (STEMI). Patients are referred for primary percutaneous coronary intervention (PPCI) if a first medical contact to device time can be achieved within 90 to 120 minutes; otherwise, fibrinolytic therapy is administered, as per guideline recommendations. Since 2011, Nova Scotian paramedics have been providing prehospital fibrinolysis (PHF) and prehospital catheterization (cath) lab activation for STEMI patients outside and within the PPCI catchment area, respectively. Patients who received fibrinolysis are transferred to a PCI facility if rescue PCI is required or if there are other indications for urgent intervention. This province wide approach is unique and the objective of this retrospective cohort study is to compare the impact of this approach on the primary outcome of 30-day mortality. Methods: For the study period, July 2011 to July 2013, STEMI patients who were diagnosed prehospital or in the ED who subsequently underwent reperfusion therapy were identified in the Emergency Health Services (EHS), Cardiovascular Information Systems (CVIS) and Cardiovascular Health Nova Scotia (CVHNS) databases. Baseline demographics and outcomes were then compared according to the treatment received: 1) PHF; 2) ED Fibrinolysis (EDF); 3) prehospital activated PPCI (EHS PPCI); and 4) ED activated PPCI (ED PPCI). Results: There were a total of 1107 STEMI patients identified during the study period, of whom 742 received lytic therapy (146 PHF; 596 EDF) and 332 underwent PPCI (202 EHS PPCI; 130 ED PPCI). Demographic variables were similar across the groups. The primary outcome of 30-day mortality was not significantly different across groups: 5 (3%) in PHF, 26 (4%) in EDF, 8 (4%) in EHS to PPCI and 2 (2%) in ED to PPCI. The number of rescue PCIs was 28 (19%) in PHF and 102 (17%) in EDF. Other outcomes (key timestamps) are pending. Conclusion: Our results show that the 30-day mortality was lowest for patients undergoing PPCI and slightly less for patients receiving pre-hospital fibrinolytic compared to those receiving ED fibrinolytic with no difference in the proportion requiring subsequent rescue PCI. The majority of patients in rural areas received EDF as opposed to PHF; pending results will show if this represents a delay in patient presentation after symptom onset.

scholarly journals Risk of active tuberculosis in migrants diagnosed with cancer: a retrospective cohort study in British Columbia, Canada

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e037827
Author(s):  
Divjot S Kumar ◽  
Lisa A Ronald ◽  
Kamila Romanowski ◽  
Caren Rose ◽  
Hennady P Shulha ◽  
...  
Keyword(s):  
British Columbia ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Population Based ◽  
Active Tuberculosis ◽  
Administrative Databases ◽  
Secondary Outcome ◽  
Cancer Type ◽  
Ltbi Screening

ObjectivesTo describe the association between types of cancer and active tuberculosis (TB) risk in migrants. Additionally, in order to better inform latent TB infection (LTBI) screening protocols, we assessed proportion of active TB cases potentially preventable through LTBI screening and treatment in migrants with cancer.DesignPopulation-based, retrospective cohort study.SettingBritish Columbia (BC), Canada.Participants1 000 764 individuals who immigrated to Canada from 1985 to 2012 and established residency in BC at any point up to 2015.Primary and secondary outcome measuresUsing linked health administrative databases and disease registries, data on demographics, comorbidities, cancer type, TB exposure and active TB diagnosis were extracted. Primary outcomes included: time to first active TB diagnoses, and risks of active TB following cancer diagnoses which were estimated using Cox extended hazard regression models. Potentially preventable TB was defined as active TB diagnosed >6 months postcancer diagnoses.ResultsActive TB risk was increased in migrants with cancer ((HR (95% CI)) 2.5 (2.0 to 3.1)), after adjustment for age, sex, TB incidence in country of origin, immigration classification, contact status and comorbidities. Highest risk was observed with lung cancer (HR 11.2 (7.4 to 16.9)) and sarcoma (HR 8.1 (3.3 to 19.5)), followed by leukaemia (HR 5.6 (3.1 to 10.2)), lymphoma (HR 4.9 (2.7 to 8.7)) and gastrointestinal cancers (HR 2.7 (1.7 to 4.4)). The majority (65.9%) of active TB cases were diagnosed >6 months postcancer diagnosis.ConclusionSpecific cancers increase active TB risk to varying degrees in the migrant population of BC, with approximately two-thirds of active TB cases identified as potentially preventable.

scholarly journals The Mortality of Older Adult Inpatients with Kidney Cancer during the Pandemic: A Retrospective Cohort Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1058-1058
Author(s):  
Kendall Brune ◽  
Cheng Yin ◽  
Rongfang Zhan ◽  
Liam O'Neill
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Kidney Cancer ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Binary Logistic Regression ◽  
Older Age ◽  
Whitney Test ◽  
Mann Whitney Test ◽  
Significant Difference

Abstract Background Elderly patients are a vulnerable group during the Covid-19 pandemic, especially those with cancer. Our study aims to identify how Covid-19 impacts elderly inpatients with kidney cancer and determine risk factors associated with increased mortality. Methods Our retrospective cohort study utilized the PUDF dataset and included inpatients over 60-year-old, diagnosed with kidney cancer, and hospitalized within 30-day. Person’s Chi-Square was used to measure the differences between survivors and non-survivors, and the Mann-Whitney test was for non-normality distribution for continuous variables. Then, a binary logistic regression was employed to identify the association between independent variables and mortality. Results Five hundred and twenty-two patients were included in the study, of which 7 (1.4%) died during hospitalization. According to the univariate analysis and Mann-Whitney test, expired patients were more likely to experience older age (p = 0.005), longer length of stay (p = 0.009), ICU (p = 0.012), HMO Medicare Risk (p = 0.005), Covid-19 (p < 0.001), paralysis (p < 0.001), and higher illness severity (p < 0.001). The binary logistic regression revealed that older age (OR = 1.120, 95% CI: 1.004-1.249, p = 0.042) and the SOI (OR = 4.635, 95% CI: 1.339-16.052, p = 0.016) had significantly high odds of mortality. Conclusion The retrospective cohort study reveals that although Covid-19 was not a predictive factor associated with increased mortality, there was a statistically significant difference between the survivor and non-survivor groups. Further studies need to assess its association with kidney cancer or other various types of cancer.

scholarly journals Prevalence of multimorbidity in adults with cancer, and associated health service utilization in Ontario, Canada: a population-based retrospective cohort study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anna Péfoyo Koné ◽  
Deborah Scharf
Keyword(s):  
Cohort Study ◽  
Health Service ◽  
Service Utilization ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Service Utilization ◽  
Premature Death ◽  
Population Based ◽  
Chronic Medical Condition ◽  
Cancer Type

Abstract Background The majority of people with cancer have at least one other chronic health condition. With each additional chronic disease, the complexity of their care increases, as does the potential for negative outcomes including premature death. In this paper, we describe cancer patients’ clinical complexity (i.e., multimorbidity; MMB) in order to inform strategic efforts to improve care and outcomes for people with cancer of all types and commonly occurring chronic diseases. Methods We conducted a population-based, retrospective cohort study of adults diagnosed with cancer between 2003 and 2013 (N = 601,331) identified in Ontario, Canada healthcare administrative data. During a five to 15-year follow-up period (through March 2018), we identified up to 16 co-occurring conditions and patient outcomes for the cohort, including health service utilization and death. Results MMB was extremely common, affecting more than 91% of people with cancer. Nearly one quarter (23%) of the population had five or more co-occurring conditions. While we saw no differences in MMB between sexes, MMB prevalence and level increased with age. MMB prevalence and type of co-occurring conditions also varied by cancer type. Overall, MMB was associated with higher rates of health service utilization and mortality, regardless of other patient characteristics, and specific conditions differentially impacted these rates. Conclusions People with cancer are likely to have at least one other chronic medical condition and the presence of MMB negatively affects health service utilization and risk of premature death. These findings can help motivate and inform health system advances to improve care quality and outcomes for people with cancer and MMB.

scholarly journals Natural history and surgical treatment of chordoma: a retrospective cohort study

2014 ◽  
Vol 132 (5) ◽  
pp. 297-302 ◽  
Author(s):  
Samuel Aguiar Júnior ◽  
Wesley Pereira Andrade ◽  
Glauco Baiocchi ◽  
Gustavo Cardoso Guimarães ◽  
Isabela Werneck Cunha ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Positive Impact ◽  
Descriptive Analysis ◽  
Long Term Results ◽  
Term Survival ◽  
Positive Margins ◽  
Mobile Spine

CONTEXT AND OBJECTIVE: Chordoma is a rare tumor with a high risk of locoregional recurrences. The aim of this study was analyze the long-term results from treating this pathological condition.DESIGN AND SETTING: Cohort study in a single hospital in São Paulo, Brazil.METHODS: This was a retrospective cohort study on 42 patients with chordoma who were treated at Hospital A. C. Camargo between 1980 and 2006. The hospital records were reviewed and a descriptive analysis was performed on the clinical-pathological variables. Survival curves were estimated using the Kaplan-Meier method and these were compared using the log-rank test.RESULTS: Nineteen patients were men and 23 were women. Twenty-five tumors (59.5%) were located in the sacrum, eleven (26.2%) in the skull base and six (14.3%) in the mobile spine. Surgery was performed on 28 patients (66.7%). The resection was considered to have negative margins in 14 cases and positive margins in 14 cases. The five-year overall survival (OS) was 45.4%. For surgical patients, the five-year OS was 64.3% (82.2% for negative margins and 51.9% for positive margins). In the inoperable group, OS was 37.7% at 24 months and 0% at five years.CONCLUSION: Complete resection is related to local control and definitively has a positive impact on long-term survival.

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