Chemotherapy and healthcare utilisation near the end of life in patients with cancer

Schulkes, Karlijn J.G.; Walree, Inez Charlotte van; Elden, Leontine J. R. van; Bos, Frederiek van den; Huis-Tanja, Lieke van; Lammers, Jan Willem J.; Huinink, Daan ten Bokkel; Hamaker, Marije E.

doi:10.1111/ecc.12796

Cited by 12 publications

(8 citation statements)

References 28 publications

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“…It is a complex decision-making process that involves patient, family, oncologist and other members of the cancer care team. Chemotherapy at the end of life could decrease survival and increase health care utilization according to some studies (1)(2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

Early Palliative Referral Reduces the Odds of Receiving Chemotherapy During the Last 30 Days of Life, a Single Center Experience From Windsor Essex, Ontario, Canada.

Woldie

Elfiki

Kulkarni

et al. 2021

Preprint

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Background: Chemotherapy use closer to the end of life is becoming an important issue in cancer care. There are now multiple studies and local reviews addressing this issue. Understanding the practice locally will give valuable insight and opportunity for improvement.Methods: The study is a retrospective chart review of patients on chemotherapy at the Windsor Regional Cancer Center who died between April 1st, 2016 to December 31st, 2018. Information on demographics, type of cancer, type, intent and route of chemotherapy, line of chemotherapy, referral to hospice and palliative care services was collected.Results: A total of 681 patients on chemotherapy died between April 1st, 2016 to Dec 13th, 2018. Of these, 119 (17.4 %) passed away within 30 days following chemotherapy. Chemotherapy was parenteral (Intravenous and Subcutaneous) for the majority (75.2%) of the patients. Most (66.4%) of the patients died of disease progression. Intent for chemotherapy was palliative in 85% of patients, adjuvant/neoadjuvant in 6.6% and curative in 8.4% of the patients. Chemotherapy was 1st, 2nd, 3rd line or more in 67.4%, 21.3% and 11.3% of the patients respectively. The type of chemotherapy was conventional in 74.3% of patients and targeted/immunotherapy in 25.7% of patients.Of the variables studied, lack of palliative referral and having lung cancer or melanoma were significantly associated with higher risk of getting chemotherapy within the last four weeks of life. The odds of getting chemotherapy in within the last four weeks of life is 0.35, 95% CI (0.24-0.53), P <0.001 for those who were referred to palliative care. On the other hand, the odds of getting chemotherapy was 4.18, 95% CI (1.17-13.71), P = 0.037 and 2.21, 95% CI (1.24-4.01), P = 0.037 for those with melanoma and lung cancer respectively.Conclusion: Administration of chemotherapy within the last 30 days of life could cause unnecessary suffering to patients and cost to society. Early referral to palliative care was significantly associated with reduced risk of getting chemotherapy within the last 30 days of life in this study. Prospective study is recommended to further investigate the role of early palliative referral on use of chemotherapy during the last 30 days of life.

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Section: Introductionmentioning

confidence: 99%

Early Palliative Referral Reduces the Odds of Receiving Chemotherapy During the Last 30 Days of Life, a Single Center Experience From Windsor Essex, Ontario, Canada.

Woldie

Elfiki

Kulkarni

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…1,28,29 Because of oncologists' inaccurate predictions and optimistic viewpoints, patients may inappropriately receive cancer treatment close to death, as demonstrated in our study, which may influence inpatient mortality, EOL care, and health care spending and utilization. [30][31][32] However, the time between therapy discontinuation and death remains an imperfect metric of aggressive or appropriate care as patients may die of completely unrelated causes. Cancer treatment, insofar as it remains safe to administer, may still help alleviate symptoms.…”

Section: Discussionmentioning

confidence: 99%

Factors and Barriers to Goals-of-Care Conversations for Patients With Cancer and Inpatient Mortality

Wheless

Lee

Domenico

et al. 2023

JCO Oncology Practice

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PURPOSE: Conversations about personal values and goals of care (GOC) at the end of life are essential in caring for patients with advanced cancer. However, GOC conversations may be influenced by patient and oncologist factors during transitions of care. METHODS: We electronically administered surveys to medical oncologists of inpatients who died from May 1, 2020, to May 31, 2021. Primary outcomes included oncologists' knowledge of inpatient death, anticipation of patient death, and recollection of GOC discussions. Secondary outcomes, including GOC documentation and advance directives (ADs), were collected retrospectively from electronic health records. Outcomes were analyzed for association with patient, oncologist, and patient-oncologist relationship factors. RESULTS: For 75 patients who died, 104/158 (66%) surveys were completed by 40 inpatient and 64 outpatient oncologists. Eighty-one oncologists (77.9%) were aware of patients' deaths, 68 (65.4%) anticipated patients' deaths within 6 months, and 67 (64.4%) recalled having GOC discussions before or during the terminal hospitalization. Outpatient oncologists were more likely to report knowledge of patient death ( P < .001), as were those with longer therapeutic relationships ( P < .001). Inpatient oncologists were more likely to correctly anticipate patient death ( P = .014). Secondary outcomes revealed 21.3% of patients had documented GOC discussions before admission and 33.3% had ADs; patients with a longer duration of cancer diagnosis were more likely to have ADs ( P = .003). Oncologist-reported barriers to GOC included unrealistic expectations from patients or family (25%) and decreased patient participation because of clinical conditions (15%). CONCLUSION: Most oncologists recalled having GOC discussions for patients with inpatient mortality, yet documentation of serious illness conversations remained suboptimal. Further studies are needed to examine barriers to GOC conversations and documentation during transitions of care and across health care settings.

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“…In 2017 in the Netherlands, 59% of cancer patients were admitted to the hospital in the last 3 months of life, and 27% visited the ER in the last month of life [46,47]. Other studies, not limited to patients with brain metastases, reported 30 to 74% of patients visiting the ER and 41 to 55% being admitted in the last 3 months of life [33,[48][49][50]. We observed that neurological symptoms were most often the reason for ER visits and hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Anti-tumor treatment and healthcare consumption near death in the era of novel treatment options for patients with melanoma brain metastases

et al. 2022

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Background Effective systemic treatments have revolutionized the management of patients with metastatic melanoma, including those with brain metastases. The extent to which these treatments influence disease trajectories close to death is unknown. Therefore, this study aimed to gain insight into provided treatments and healthcare consumption during the last 3 months of life in patients with melanoma brain metastases. Methods Retrospective, single-center study, including consecutive patients with melanoma brain metastases diagnosed between June-2015 and June-2018, referred to the medical oncologist, and died before November-2019. Patient and tumor characteristics, anti-tumor treatments, healthcare consumption, presence of neurological symptoms, and do-not-resuscitate status were extracted from medical charts. Results 100 patients were included. A BRAF-mutation was present in 66 patients. Systemic anti-tumor therapy was given to 72% of patients during the last 3 months of life, 34% in the last month, and 6% in the last week. Patients with a BRAF-mutation more frequently received systemic treatment during the last 3 (85% vs. 47%) and last month (42% vs. 18%) of life than patients without a BRAF-mutation. Furthermore, patients receiving systemic treatment were more likely to visit the emergency room (ER, 75% vs. 36%) and be hospitalized (75% vs. 36%) than those who did not. Conclusion The majority of patients with melanoma brain metastases received anti-tumor treatment during the last 3 months of life. ER visits and hospitalizations occurred more often in patients on anti-tumor treatment. Further research is warranted to examine the impact of anti-tumor treatments close to death on symptom burden and care satisfaction.

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Chemotherapy and healthcare utilisation near the end of life in patients with cancer

Cited by 12 publications

References 28 publications

Early Palliative Referral Reduces the Odds of Receiving Chemotherapy During the Last 30 Days of Life, a Single Center Experience From Windsor Essex, Ontario, Canada.

Early Palliative Referral Reduces the Odds of Receiving Chemotherapy During the Last 30 Days of Life, a Single Center Experience From Windsor Essex, Ontario, Canada.

Factors and Barriers to Goals-of-Care Conversations for Patients With Cancer and Inpatient Mortality

Anti-tumor treatment and healthcare consumption near death in the era of novel treatment options for patients with melanoma brain metastases

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