receiving more than 10 days of radiation therapy in the last 30 days of life or having fewer than 3 days of hospice enrollment. In subgroup analysis, patients with alcohol use disorder were more likely to have ED visits (aOR 1.16, 95% CI 1.09-1.24), hospitalizations (aOR 1.22, 95% CI 1.14-1.31), and ICU admissions (aOR 1.17, 95% CI 1.11-1.24), die in the hospital (aOR 1.08, 95% CI 1.03-1.14), and have late or no hospice enrollments at the end of life (aOR 1.07, 95% CI 1.02-1.13), but less likely to receive chemotherapy (aOR 0.74, 95% CI 0.65-0.85) at this stage. Patients with opioid use disorders had the highest odds of visiting the ED multiple times (aOR 1.56, 95% CI 1.34-1.81) prior to death. Conclusion: Substance use disorder is associated with poorer quality of EOL cancer care, especially with regards to frequent use of acute care services such as the ED, hospital, and intensive care unit.
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