Impact of dementia on quality of death among cancer patients: An observational study of home palliative care users

Abstract

Aim The number of cancer patients with dementia has increased markedly in accordance with aging societies. Cancer patients might receive palliative and end‐of‐life care to maintain their quality of life; however, the impact of dementia on the quality of death is unexamined in this population. Consequently, we explored the impact of dementia on the quality of death among cancer patients. Methods Home palliative care staff members completed questionnaires regarding cancer patients’ (n = 508) cognitive status, cancer‐related symptoms and quality of death using the good death inventory. Hierarchical regression analyses were carried out for the entire sample and for stratified groups based on the presence of dementia. Results Of the 508 patients, 156 (30.7%) had dementia. Hierarchical regression analyses revealed that greater quality of death was associated with not having dementia (P < 0.001). Stratified analyses showed that dying at home was related to greater quality of death both in patients with and without dementia. The presence of a primary family caregiver was associated with greater quality of death only in patients with dementia (P < 0.001). Conclusions Cancer patients with dementia were less likely to achieve a good death than those without. Our results suggest the importance of enhancing end‐of‐life care discussions with patients and their families, along with developing specific support strategies to enhance the decision‐making of cancer patients with dementia and their family members. Geriatr Gerontol Int 2020; 20: 354–359.

Cancer care for people with dementia: Literature overview and recommendations for practice and research

“…Several studies have examined pharmacologic pain management in PLWD who have comorbid cancer in a range of countries and care settings, including postoperatively after cancer surgery and during the final weeks of life. 42,62,[93][94][95][96][97][98][99] These studies generally show that patients who have cancer with dementia receive significantly fewer analgesics than those without dementia, including opioids, nonopioids, and adjuvants like corticosteroids. 42,62,[94][95][96][97] Monroe et al, who did not include a nondementia control group, found a gradient of lower opioid administration with increasing dementia severity among patients with advanced cancer.…”

“…42,62,[93][94][95][96][97][98][99] These studies generally show that patients who have cancer with dementia receive significantly fewer analgesics than those without dementia, including opioids, nonopioids, and adjuvants like corticosteroids. 42,62,[94][95][96][97] Monroe et al, who did not include a nondementia control group, found a gradient of lower opioid administration with increasing dementia severity among patients with advanced cancer. 98,99 In contrast, in a nursing home study in Norway, Blytt et al found no significant differences in pain medication use between PLWD and comorbid cancer and those who had cancer alone, 93 although a recent review of analgesic provision generally in PLWD found that studies in Nordic countries have reported few dementia-related differences in opioid prescribing relative to studies in the United States and Europe.…”

“…98,99 In contrast, in a nursing home study in Norway, Blytt et al found no significant differences in pain medication use between PLWD and comorbid cancer and those who had cancer alone, 93 although a recent review of analgesic provision generally in PLWD found that studies in Nordic countries have reported few dementia-related differences in opioid prescribing relative to studies in the United States and Europe. 100 Three of the studies examining pain medication in this comorbid patient group also examined pain complaints or behaviors in care records and found significantly fewer recorded for PLWD compared with people without dementia 62,94 or for people with advanced-stage versus earlier-stage dementia. 98 It has been hypothesized that PLWD have increased pain threshold and tolerance because of the neuropathologic changes underpinning dementia, 101,102 and Iritani et al…”

“…Several studies have examined pharmacologic pain management in PLWD who have comorbid cancer in a range of countries and care settings, including postoperatively after cancer surgery and during the final weeks of life 42,62,93‐99 . These studies generally show that patients who have cancer with dementia receive significantly fewer analgesics than those without dementia, including opioids, nonopioids, and adjuvants like corticosteroids 42,62,94‐97 .…”

Prevalence and health outcomes in community-dwelling older adults with comorbid cancer and dementia: a longitudinal analysis

“…Several studies have examined healthcare utilization and single patient outcomes in individuals with comorbid cancer and dementia, such as survival (Jazzar et al, 2020;McWilliams et al, 2018;Robb et al, 2010), mortality (Baillargeon et al, 2011), death/quality of death (Hirooka et al, 2020), hospice use (Legler et al, 2011;Monroe et al, 2013), quality of life (Blytt et al, 2018), hospitalizations (Legler et al, 2011;Teno et al, 2013), or healthcare cost (Chastek et al, 2012). These studies found that individuals with comorbid cancer and dementia had worse outcomes in general, however, they only examined one health outcome in isolation.…”