Low Socioeconomic Status Is Associated With More Aggressive End-of-Life Care for Working-Age Terminal Cancer Patients

Chang, Chin-Chun; Wu, Chin-Chia; Yin, Weiqiang; Juang, Shiun-Yang; Yu, Chia-Hui; Lee, Ching‐Chih

doi:10.1634/theoncologist.2014-0152

Cited by 31 publications

(33 citation statements)

References 41 publications

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“…Diagnosis status was divided into three subgroups of cancers that were homogeneous in terms of survival and disease course [18][19][20]. Patients with nonmetastatic cancer and hematologic malignancies were excluded from this study.…”

Section: Databasementioning

confidence: 99%

Palliative Chemotherapy Affects Aggressiveness of End-of-Life Care

Hsu

Chang

et al. 2016

The Oncologist

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Introduction. Although palliative chemotherapy during end‐of‐life care is used for relief of symptoms in patients with metastatic cancer, chemotherapy may lead to more aggressive end‐of‐life care and less use of hospice service. This is a population‐based study of the association between palliative chemotherapy and aggressiveness of end‐of‐life care. Patients and Methods. Using the National Health Insurance Research Database of Taiwan, we identified 49,920 patients with metastatic cancer who underwent palliative chemotherapy from January 1, 2009, to December 31, 2011. Patients who received chemotherapy 2–6 months before death were included. Aggressiveness of end‐of‐life care was examined by previously reported indicators. Cardiopulmonary resuscitation and endotracheal tube intubation were included as indicators of aggressive end‐of‐life care. The association between palliative chemotherapy and hospice care was studied. Results. Palliative chemotherapy was associated with more aggressive treatment. After adjustment for patient age, sex, Charlson Comorbidity Index score, cancer group, primary physician's specialty, postdiagnosis survival, hospital characteristics, hospital caseload, urbanization, and geographic regions, more than one emergency room visit (p < .001), more than one intensive care unit admission (p < .001), and endotracheal intubation (p = .02) during end‐of‐life care were significantly more common in patients receiving palliative chemotherapy. Patients who did not receive palliative chemotherapy received more hospice care in the last 6 months of life (p < .001). Conclusion. Although the decision to initiate palliative chemotherapy was made several months before death, this study showed that palliative chemotherapy was associated with more aggressive end‐of‐life care, including more emergency room visits and intensive care unit admissions, and endotracheal intubation. The patients who received palliative chemotherapy received less hospice service toward the end of life. Implications for Practice: Palliative chemotherapy is used for patients with incurable cancer toward the end of life (EOL). Aggressiveness of EOL care and hospice care are related to the quality of life of these patients. This study of data from the Taiwanese National Health Insurance Research Database found that palliative chemotherapy led to more aggressive EOL care and less hospice care. There is a need to provide patients with terminal cancer access to care information that best meets their needs, especially those patients who receive palliative chemotherapy.

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Section: Databasementioning

confidence: 99%

Palliative Chemotherapy Affects Aggressiveness of End-of-Life Care

Hsu

Chang

et al. 2016

The Oncologist

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“…Statistics Belgium also manages the national demographic database, derived from the population register [ 16 ] and containing for example the household composition of every citizen and data from the Socio-Economic Survey 2001 and Census 2011, nationwide full population surveys based on the tradition of population count [ 17 ]. The database contains information about the highest educational level attained, the last held occupation (as a measure of socio-economic position) and housing characteristics, which are all socio-economic factors that have been identified in previous studies as affecting end-of-life care patterns [ 18 – 20 ]. Finally a database containing fiscal data (i.e.…”

Section: Resultsmentioning

confidence: 99%

Using linked administrative and disease-specific databases to study end-of-life care on a population level

et al. 2016

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BackgroundThe use of full-population databases is under-explored to study the use, quality and costs of end-of-life care. Using the case of Belgium, we explored: (1) which full-population databases provide valid information about end-of-life care, (2) what procedures are there to use these databases, and (3) what is needed to integrate separate databases.MethodsTechnical and privacy-related aspects of linking and accessing Belgian administrative databases and disease registries were assessed in cooperation with the database administrators and privacy commission bodies. For all relevant databases, we followed procedures in cooperation with database administrators to link the databases and to access the data.ResultsWe identified several databases as fitting for end-of-life care research in Belgium: the InterMutualistic Agency's national registry of health care claims data, the Belgian Cancer Registry including data on incidence of cancer, and databases administrated by Statistics Belgium including data from the death certificate database, the socio-economic survey and fiscal data. To obtain access to the data, approval was required from all database administrators, supervisory bodies and two separate national privacy bodies. Two Trusted Third Parties linked the databases via a deterministic matching procedure using multiple encrypted social security numbers.ConclusionIn this article we describe how various routinely collected population-level databases and disease registries can be accessed and linked to study patterns in the use, quality and costs of end-of-life care in the full population and in specific diagnostic groups.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-016-0159-7) contains supplementary material, which is available to authorized users.

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“…This result was dissimilar to the result of a study in Taiwan. The previous study found that patients with low socioeconomic status, have metastatic malignant disease, residing in urban areas or are in hospitals with more abundant health care resources are likely to receive aggressive end-oflife care to delay death [18]. However, one American study reported that patients living in low-income zip codes are less likely to receive aggressive end-of-life cancer treatment than patients living in other zip codes [19].…”

Section: Predictors Of Preferring Receiving Appropriate Palliative Carementioning

confidence: 99%

Advance Directives and End-of-Life Care: Knowledge and Preferences of Patients with Brain Tumours from Anhui, China

Wang

Zhang

Hong

et al. 2020

Preprint

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Abstract Background: In Mainland China, the advance directives (ADs) and end-of-life care of patients with tumours, especially patients with brain tumours who may have lost consciousness or the ability to speak at the early stage of their illness, have been poorly acknowledged. Thus, this study aims to clarify the knowledge and preferences of the ADs and end-of-life care of patients with brain tumours and to investigate the predictors of patients’ preferences.Methods: This was a population-based cross-sectional survey that was conducted via face-to-face interviews. Information on the sociodemographic factors, brain tumour illness, knowledge and preferences of the advance decisions and end-of-life care of the patients were collected.Results: A total of 88.61% of the participants had never heard of ADs, but 65.18% would like to make ADs. Knowledge of ADs, receiving surgical treatment or radiotherapy, less than 70 years old, male, educational qualifications of college or beyond, childless, had medical insurance for nonworking or working urban residents and self-payment of medical expenses were predictors of preference for making ADs. A total of 79.43% participants would like to discuss end-of-life arrangements with medical staff, and 63.29% of participants were willing to receive end-of-life care although it could not delay death. A total of 65.82% patients with brain tumours wanted resuscitation, and as high as 45.45% of the patients thought that they did not need life support if they were in a persistent vegetative state. Brain primary tumours, ages of less than 70 years old, male, educational qualification of junior middle school or below, had children, had new rural cooperative medical insurance and had medical expenses paid by children or spouses were predictors of choosing appropriate palliative care.Conclusions：ADs and end-of-life care have been poorly acknowledged amongst patients with brain tumours in mainland China. Additional efforts should be encouraged amongst patients with primary brain tumours, those are undergoing surgery and radiotherapy and those who have low socioeconomic status. Appropriate decision-making timing is encouraged to promote AD amongst Chinese patients with brain tumours.

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Low Socioeconomic Status Is Associated With More Aggressive End-of-Life Care for Working-Age Terminal Cancer Patients

Cited by 31 publications

References 41 publications

Palliative Chemotherapy Affects Aggressiveness of End-of-Life Care

Palliative Chemotherapy Affects Aggressiveness of End-of-Life Care

Using linked administrative and disease-specific databases to study end-of-life care on a population level

Advance Directives and End-of-Life Care: Knowledge and Preferences of Patients with Brain Tumours from Anhui, China

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