Healthcare Use during the Last Six Months of Life in Patients with Advanced Breast Cancer

Abstract

New treatment options in cancer have resulted in increased use of health care resources near the end of life. We assessed health care use near the end of life of patients with advanced breast cancer (ABC). From the Southeast Netherlands Breast cancer (SONABRE) registry, we selected all deceased patients diagnosed with ABC in Maastricht University Medical Center between January 2007 and October 2017. Frequency of health care use in the last six months of life was described and predictors for health care use were assessed. Of 203 patients, 76% were admitted during the last six months, 6% to the intensive care unit (ICU) and 2% underwent cardiopulmonary resuscitation (CPR). Death in hospital occurred in 25%. Nine percent of patients received a new line of chemotherapy ≤30 days before death, which was associated with age <65 years and <1 year survival since diagnosis of metastases. In these patients, the hospital admission rate was 95%, of which 79% died in the hospital, mostly due to progressive disease (80%). In conclusion, the frequency of ICU-admission, CPR or a new line of chemotherapy ≤ 30 days before death was low. Most patients receiving a new line of chemotherapy ≤ 30 days before death, died in the hospital.

Patterns of care at the end of life: A retrospective study of Italian patients with advanced breast cancer.

“…At the same time, the 18.2% frequency of hospital deaths we found is much lower than the rate reported for Italian cancer patients in a cross-national European end-oflife study, in which hospital death rates were lowest for Dutch patients (28%), and highest for Italian patients (39%). It is also lower than the rate reported by a recent Dutch study on healthcare use during the last six months of life in patients with advanced breast cancer (25%) 15 . In addition, a population-based study on intensity of care, expenditure, and place of death of French women with breast cancer found that almost 70% of these patients died at hospital 27 .…”

“…Although cross-study comparisons should be taken with caution, we note that this frequency is lower than reported in other studies on patients with advanced breast cancer. Schmitz et al, for instance, found a higher admission rate of 76% within 6 months of death 15 , while Tanguy-Melac and colleagues found a 90% hospital admission rate in an advanced breast cancer population over 12 months 17 . While the former study reported that age <65 years, de novo metastatic breast cancer, and a survival time <1 year were associated with hospital admissions within six months of death, in our study, these were most frequently associated with comorbidities and concomitant medications, particularly steroids.…”

“…A better understanding of utilization patterns of anticancer drugs and other healthcare resources at the end of patients' life may facilitate shared decision-making on starting or discontinuing active treatment 15 .…”

“…Thus, it may lead to improved EoL care and QoL in patients with advanced breast cancer, as well as enable health systems to plan and allocate resources properly. Nevertheless, there is a paucity of information in literature about the use of healthcare resources for patients with speci c cancer types, including breast cancer, during the EoL 15 . Aim of this retrospective observational study, we evaluated the use of healthcare resources in the last six months of life of advanced breast cancer patients.…”

Patterns of care at the end of life: a retrospective study of Italian patients with advanced breast cancer

“…A better understanding of utilization patterns of anticancer drugs and other healthcare resources at the end of patients’lives may facilitate shared decision-making on starting or discontinuing active treatment [ 19 ]. Thus, it may lead to improved EoL care and QoL in patients with advanced breast cancer, as well as enable health systems to plan and allocate resources properly.…”