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Showing content from https://pubmed.ncbi.nlm.nih.gov/28954284/ below:

Aggressive End-of-Life Care for Metastatic Cancer Patients Younger Than Age 65 Years

. 2017 Sep 1;109(9):djx028. doi: 10.1093/jnci/djx028. Aggressive End-of-Life Care for Metastatic Cancer Patients Younger Than Age 65 Years

Affiliations

Affiliation

¹ Department of Radiation Oncology, Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Lineberger Comprehensive Cancer Center, Department of Health Policy and Management, Gillings School of Global Public Health, and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; HealthCore, Inc., Alexandria, VA.

PMID: 28954284
PMCID: PMC6440271
DOI: 10.1093/jnci/djx028

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Aggressive End-of-Life Care for Metastatic Cancer Patients Younger Than Age 65 Years

Aaron D Falchook et al. J Natl Cancer Inst. 2017.

. 2017 Sep 1;109(9):djx028. doi: 10.1093/jnci/djx028. Affiliation

¹ Department of Radiation Oncology, Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Lineberger Comprehensive Cancer Center, Department of Health Policy and Management, Gillings School of Global Public Health, and Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; HealthCore, Inc., Alexandria, VA.

PMID: 28954284
PMCID: PMC6440271
DOI: 10.1093/jnci/djx028

Item in Clipboard

Abstract

Background: Aggressive medical care at the end of life can be harmful to patients and families, but its prevalence in use among younger cancer patients is unknown. The goal of the study was to report on the use of aggressive care and hospice services for patients younger than age 65 years.

Methods: Using the HealthCore Integrated Research Database, we analyzed patients who died between 2007 and 2014 with metastatic lung (n = 12 764), colorectal (n = 5207), breast (n = 5855), pancreatic (n = 3397), or prostate (n = 1508) cancer. Based on published quality measures, we assessed uses of chemotherapy, intensive care, emergency room visits, and hospice care at the end of life. We examined additional items including radiotherapy, invasive procedures, hospitalization, and in-hospital deaths. Multivariable modified Poisson regression models were used to adjust for age, sex, geographic region, rural/urban location, year of death, and regional education and income measures.

Results: Across the five cancers, 10.1% to 14.1% of patients received chemotherapy within the last 14 days of life, 15.9% to 20.6% received intensive care in last 30 days, and 1.5% to 2.5% went to the emergency room two or more times in last 30 days. Hospice enrollment at least three days before death was 54.4% to 59.6%. However, 55.3% to 59.3% of patients had a hospital admission in the last 30 days, and one-third died (30.3%-35.4%) in the hospital.

Conclusions: There was low use of cancer-directed treatment at the end of life for younger cancer patients, and hospice use was higher than 50%. However, there was a relatively high utilization of hospital-based care. These results demonstrate an opportunity for continued improvements in the provision of high-value, patient-centered care at the end of life.

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Figures
Figure 1.

Proximity of aggressive care to…

Figure 1.

Proximity of aggressive care to the end of life. The histograms show proximity…

Figure 1.

Proximity of aggressive care to the end of life. The histograms show proximity of aggressive care to patients’ date of death. In each graph, patients are “counted” only once, on the day when they last received each aggressive care measure before death. The y-axes represent the overall proportion of patients out of the entire analytic cohort. ICU = intensive care unit.

Figure 2.

Proximity of hospice enrollment to…

Figure 2.

Proximity of hospice enrollment to the end of life. The histogram shows proximity…

Figure 2.

Proximity of hospice enrollment to the end of life. The histogram shows proximity of hospice enrollment to patients’ date of death. The first date on which hospice services were received was considered to be the date of hospice enrollment. The first bar on the histogram indicates the percentage of patients who were enrolled in hospice between 91 and 365 days before death. The y-axis represents the overall proportion of patients out of the entire analytic cohort.