Increasing our understanding of dying of breast cancer: Comorbidities and care

Abstract

Background: Screening and treatment for breast cancer have improved. However, attention to palliative support and non-cancer co-morbidities has been limited. This study identified types of care for and co-morbidities of persons dying of breast cancer compared to persons dying from all cancers and from non-cancer causes. Methods: Linked administrative data from population-based registries were used to examine 121,458 deaths in Nova Scotia from 1995 to 2009. Results: Breast cancer decedents' mean age was similar to that of all cancer decedents (72.0 versus 72.1 years), but their age spread was greater (20–59 years: 23.1% versus 16.7%; 90+ years: 11.2% versus 6.5%). Among women dying of breast cancer, 15.6% were enrolled in the diabetes registry and 15.1% in the cardiovascular registry, indicating that they had these non-cancer conditions prior to their death. Compared to all cancer decedents, breast cancer decedents were twice as likely to have dementia as a cause of death, and were less likely to die in hospital but more likely to die in a nursing home. Breast cancer decedents had place of death rates more similar to non-cancer than cancer decedents. Conclusions: Rates of dementia and diabetes among the breast cancer decedents were particularly note-worthy in this novel study given that these comorbidities have not received much attention in the breast cancer research literature. Further collaboration with non-cancer disease programs is advised. The extent of adequate comprehensive palliative support for the 20% of the breast cancer decedents who are nursing home residents requires investigation.

Intensity of Care, Expenditure, and Place of Death in French Women in the Year Before Their Death From Breast Cancer: A Population-Based Study

“…5 The proportion of each place of death and the mode of management may vary according to the definition of the cases included, either people who died with a managed cancer or, inversely, people for whom a cancer was the main cause of death, the study period, but also according to age, the type of cancer, its stage and its history, and any comorbidities, including concomitant cancers and the development and organization of palliative care. [5][6][7][21][22][23][24][25][26][27][28][29][30][31][32][33] Observed frequencies also vary according to organization of end-of-life care or palliative care in each country, either mainly in short-stay hospitals, as in France, or by preferring discharge from hospital and management at home or in hospices.…”

Cultural and Ethical Barriers to Cancer Treatment in Nursing Homes and Educational Strategies: A Scoping Review

“…This category includes nine studies distributed in two subcategories: mortality of cancer in nursing homes and caring [ 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ].…”

“…According to a population-based study conducted in Nova Scotia, Canada, breast cancer decedents were more likely to die in a nursing home compared to all-cancer causes and were twice as likely to have dementia as a cause of death [ 58 ]. In a study conducted by Bainbridge et al, 61.3% of residents had visited an emergency department in the last 6 months of life and 20.4% had died in hospital.…”

“…It is known that certain treatments against cancer in frail patients can lead to functional decline and excess mortality [27][28][29][30]. However, there was no published study found on the outcomes and feasibility of chemotherapeutic treatment in nursing home residents, Cancer is a frequent cause of death in nursing homes [58,61,63], although death is more related to functional decline than to tumor cancer itself [62]. When approaching the end of life, caring for a dying patient is known to be challenging [64][65][66].…”

“…Cancer is a frequent cause of death in nursing homes [ 58 , 61 , 63 ], although death is more related to functional decline than to tumor cancer itself [ 62 ]. When approaching the end of life, caring for a dying patient is known to be challenging [ 64 , 65 , 66 ].…”