Disparities in place of death for patients with primary brain tumors and brain metastases in the USA

Shenker, R.F.; McLaughlin, Mary Elizabeth; Chino, Fumiko; Chino, Junzo

doi:10.1007/s00520-022-07120-4

Cited by 2 publications

(2 citation statements)

References 41 publications

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“…Dying out-of-hospital is also associated with increasing age in cancer patients in our study, a trend consistent with previous findings. 34-36 One prospective study in South Africa compared the stated preferences of cancer patients with actual POD. There were no differences in preferred POD but the mean age of the patients who in fact died at home was 60.2 years, compared to 55 years for those who died at a hospital or facility.…”

Section: Discussionmentioning

confidence: 99%

“…First, the cause of death database did not include patients’ ethnicity, socioeconomic status, or level of religious observance, all of which had been found to have an impact on the POD. 34 , 35 , 43 In addition, the POD variable has only 2 categories (in-hospital and out-of-hospital). People who died out-of-hospital may have died at home or in facilities not classified as general/geriatric hospitals.…”

Section: Discussionmentioning

confidence: 99%

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Place of Death for Israeli Cancer Patients Over a 20-Year Period: Reducing Hospital Deaths, but Barriers Remain

Shalev Many,

Shvartzman,

Wolf

et al. 2023

The Oncologist

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Background Cancer remains a leading cause of mortality worldwide. While the main focus of palliative care (PC) is quality of life, the elements that comprise the quality of death are often overlooked. Dying at home, with home-hospice-care (HHC) support, rather than in-hospital, may increase patient satisfaction and decrease the use of invasive measures. We examined clinical and demographic characteristics associated with out-of-hospital death among patients with cancer, which serves as a proxy measure for HHC deaths. Methods Using death certification data from the Israel Central Bureau of Statistics, we analyzed 209,158 cancer deaths between 1998 and 2018 in Israel including demographic information, cause of death, and place of death (POD). A multiple logistic regression model was constructed to identify factors associated with out-of-hospital cancer deaths. Results Between 1998 and 2018, 69.1% of cancer deaths occurred in-hospital, and 30.8% out-of-hospital. Out-of-hospital deaths increased by 1% annually during the study period. Older patients and those dying of solid malignancies were more likely to die out-of-hospital (OR = 2.65, OR = 1.93, respectively). Likelihood of dying out-of-hospital varied with area of residency; patients living in the Southern district were more likely than those in the Jerusalem district to die out-of-hospital (OR = 2.37). Conclusion The proportion of cancer deaths occurring out-of-hospital increased during the study period. We identified clinical and demographic factors associated with POD. Differences between geographical areas probably stem from disparity in the distribution of PC services and highlight the need for increasing access to primary EOL care. However, differences in age and tumor type probably reflect cultural changes and suggest focusing on educating patients, families, and physicians on the benefits of PC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Place of Death for Israeli Cancer Patients Over a 20-Year Period: Reducing Hospital Deaths, but Barriers Remain

Shalev Many,

Shvartzman,

Wolf

et al. 2023

The Oncologist

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Role of Hospital Connectedness in Brain Metastasis Outcomes

Tong,

Patel,

Aizer

et al. 2024

JAMA Netw Open

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ImportanceAlthough patients with brain metastases receive interdisciplinary and multi-institutional care, the association between neuro-oncologic care networks and patient outcomes remains unknown. As patients often interact with multiple facilities, quantifying this association across a network of hospitals is critical to capture the complexity of the health care journey for patients with brain metastases.ObjectiveTo evaluate how statewide health care network metrics are associated with inpatient mortality and hospital length of stay (LOS) for patients with brain metastases.Design, Setting, and ParticipantsThis multicenter, statewide cohort study used data from the 2018 to 2019 Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases. Primary analyses were completed by August 2023. Participants included adults with a brain metastases receiving care in Massachusetts.ExposureAll inpatient and emergency department visits mapped for patients following the first diagnosis of brain metastasis.Main Outcomes and MeasuresInpatient mortality and hospital LOS were the main outcomes assessed. Hospital interdependence in brain metastases care was calculated using a connectedness score (weighted degree: weighted sum of ties to other care facilities). The association between hospital connectedness and clinical outcomes was analyzed using mixed-effects logistic and linear regression models, adjusting for hospital-level features.ResultsIn this cohort study, 4679 patients with brain metastases were identified with inpatient or ED encounters in Massachusetts (from 2018 to 2019). The median (IQR) age was 64 (57-73) years, and 2559 (55%) were female. There was interdependence in brain metastases care, with 993 patients (21%) visiting 2 or more unique hospitals. Highly connected hospitals were heterogeneous, with many being small and one-half lacking subspecialty neuro-oncologic care or teaching status. Increased hospital connectedness was significantly associated with improved inpatient mortality for patients with brain metastases, with the lowest connectedness quartile associated with more than double the risk of mortality compared with the highest quartile (odds ratio, 2.34; 95% CI, 1.33-4.11; P = .003). A stepwise increase in inpatient mortality risk was observed as hospital connectedness decreased, independently of hospital volume. Furthermore, intermediate hospital connectedness was associated with increased hospital LOS (coefficient, 1.08; 95% CI, 0.17-1.95; P = .006).Conclusions and RelevanceThis study found that hospital-to-hospital interconnectedness was significantly associated with improved clinical outcomes for patients with brain metastases. The salience of network metrics highlights their potential role alongside other patient-level and hospital-level variables to evaluate and improve oncology care delivery.

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Disparities in place of death for patients with primary brain tumors and brain metastases in the USA

Cited by 2 publications

References 41 publications

Place of Death for Israeli Cancer Patients Over a 20-Year Period: Reducing Hospital Deaths, but Barriers Remain

Place of Death for Israeli Cancer Patients Over a 20-Year Period: Reducing Hospital Deaths, but Barriers Remain

Role of Hospital Connectedness in Brain Metastasis Outcomes

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