Comparing Noncancer and Cancer Deaths in Hong Kong: A Retrospective Review

Abstract

This retrospective study aimed to compare noncancer deaths with cancer deaths in the following: 1) utilization of the public health care system in the last six months of life; 2) end-of-life care received; and 3) documentation of the advance care planning (ACP) process. The following sample was recruited from the deaths in 2006 in four public hospitals for analysis: 656 noncancer deaths consisting of 239 deaths from chronic renal failure (CRF), 242 deaths from chronic obstructive pulmonary disease (COPD) and 175 deaths from congestive heart failure (CHF), and 183 cancer deaths. Only 1.4% of noncancer patients received palliative care, compared with 79.2% of cancer patients. As compared with cancer, the noncancer patients were older (79.1±9.5 vs. 71.1±12.4 years, P<0.001) and had more comorbid conditions (2.3±1.4 vs. 1.6±1.4, P<0.001). Utilization of public health care was more intensive in noncancer patients, with more intensive care unit admissions, more ward admissions, more bed days occupied, and more clinic attendances. Within the last two weeks of life, the noncancer patients had more invasive interventions initiated, fewer symptoms documented, less analgesics and sedatives prescribed, less do-not-resuscitate orders in place, and more cardiopulomonary resuscitation performed. Dyspnea, edema, pain, and fatigue were among the most documented symptoms in both cancer and noncancer patients. A higher proportion of ACP discussions were first documented within three days before death in COPD and CHF patients as compared with CRF and cancer patients. There is a need to develop palliative care for noncancer patients in Hong Kong.

Improving end-of-life care for patients with chronic obstructive pulmonary disease

“…Doing a brief PubMed search using 10 years, humans and English language as filters, revealed the following: palliative care and COPD: 220 publications; palliative care and cancer: 9214 publications. A retrospective review published in 2010 compared cancer versus noncancer deaths in Hong Kong in regards to utilization of public healthcare in the last 6 months of life, end-of-life care provided and documentation of any advance care planning [Lau et al 2010]. Of the total number diagnosed with nonmalignant disease, over a third (36.8%) were diagnosed with COPD.…”

“…Of the total number diagnosed with nonmalignant disease, over a third (36.8%) were diagnosed with COPD. Overall percentages determined from the review revealed that palliative care was provided to 79.2% of patients with cancer but only 1.4% of patients without cancer [Lau et al 2010]. Additionally, within the last 2 weeks of life, patients with nonmalignant diagnoses received more invasive interventions, had fewer symptoms documented, fewer sedatives or analgesics prescribed and more cardiopulmonary resuscitation performed.…”

“…Additionally, within the last 2 weeks of life, patients with nonmalignant diagnoses received more invasive interventions, had fewer symptoms documented, fewer sedatives or analgesics prescribed and more cardiopulmonary resuscitation performed. When advance care planning was done, a higher proportion of the discussions were first documented within 3 days of death in COPD and congestive heart failure compared with patients with cancer and chronic renal failure [Lau et al 2010]. Other authors and researchers have concluded similar inequalities between palliative care provided to patients with and without cancer.…”

Comparison of End-of-Life Care Intensity between Cancer and Non-cancer Patients: a Single Center Experience

“…이처럼 임종기 환자들의 사망원인은 다양함에도 불구하고, 암환자와 비-암환자 를 비교한 임종기 관리에 대한 연구는 국외에서 몇몇 연구들이 진행된 바는 있으나 (6,7), 국내 연구는 대부분 암환자에 국한되어 있다 (3,8,9).…”

Physical and Psychospiritual Care Need by End-of-life Stages among Non-cancer Patient at Home: Based on the Importance and Difficulty of Care Need

“…예를 들어 Ostgathe 등(2010) (Ernstmann et al, 2009;Jenkins, Fallowfield, & Saul, 2001;Kwon & Eun, 1998;Longman, Atwood, Sherman, Benedict, & Shang, 1992;Mcillmurray et al, 2001;Morasso et al, 1999), 비 암 환자를 대상으로 실시된 연구도 있으나 (Fitzsimons et al, 2007;Lau et al, 2010;Luddington et al, 2001;Ostgathe et al, 2010) (Kamei, Shimanouchi, & Nakayama, 1999;Kwon & Eun, 1999;Sanders, Bantum, Owen, Thornton, & Stanton, 2010 …”