Palliative Care Needs of Cancer Patients in U.S. Nursing Homes

Johnson, Vanessa M.P.; Teno, Joan M.; Bourbonniere, Meg; Mor, Vincent

doi:10.1089/jpm.2005.8.273

Cited by 66 publications

(58 citation statements)

References 22 publications

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“…Previous research also found that nursing home residents were less likely to have received palliative radiation and a medical oncology consultation in the last months of life [16,23,39,41]. Reasons why nursing home residents are not receiving the same level of oncology services as those who do not reside in nursing homes need to be studied further.…”

Section: Discussionmentioning

confidence: 96%

“…Only 4.8% of nursing home residents with cancer were noted to be obtaining hospice services, with the percentage rising to 11% among those terminally ill [23].…”

Section: Introductionmentioning

confidence: 99%

“…In some US states, the proportion of deaths occurring in nursing homes now exceeds 30% and, by 2040, is expected to exceed 40% [30]. Approximately 11% have a cancer diagnosis upon admission to a nursing home [7] and approximately 10% of the nursing home population has a cancer diagnosis that affects their function and/or treatment [23]. A significant proportion of nursing home residents with cancer have daily pain (24-38%), over a quarter of which goes entirely untreated [4,7].…”

Section: Introductionmentioning

confidence: 99%

“…A significant proportion of nursing home residents with cancer have daily pain (24-38%), over a quarter of which goes entirely untreated [4,7]. Between 6 and 24% of cancer patients die in nursing homes [2,6,17,18,22,23,28,29,34]. Nursing homes are not generally viewed as having well-developed expertise in care for dying people [33].…”

Section: Introductionmentioning

confidence: 99%

“…Relatively few nursing home residents with cancer receive active cancer treatment [7,16,23,39,41] despite the fact that research has shown that active treatment can be as effective and as well tolerated in the elderly as in younger patients [3,31,39]. Only 4.8% of nursing home residents with cancer were noted to be obtaining hospice services, with the percentage rising to 11% among those terminally ill [23].…”

Section: Introductionmentioning

confidence: 99%

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End-of-life care for nursing home residents dying from cancer in Nova Scotia, Canada, 2000–2003

O’Brien

Johnston

Gao

et al. 2007

Support Care Cancer

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Section: Discussionmentioning

confidence: 96%

“…Only 4.8% of nursing home residents with cancer were noted to be obtaining hospice services, with the percentage rising to 11% among those terminally ill [23].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

End-of-life care for nursing home residents dying from cancer in Nova Scotia, Canada, 2000–2003

O’Brien

Johnston

Gao

et al. 2007

Support Care Cancer

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Incidence of Aggressive End-of-Life Care Among Older Adults With Metastatic Cancer Living in Nursing Homes and Community Settings

Koroukian

Douglas

et al. 2023

JAMA Netw Open

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ImportanceNearly 10% of the 1.5 million persons residing in nursing homes (NHs) have received or will receive a diagnosis of cancer. Although aggressive end-of-life (EOL) care is common among community-dwelling patients with cancer, little is known about such patterns of care among NH residents with cancer.ObjectiveTo compare markers of aggressive EOL care between older adults with metastatic cancer who are NH residents and their community-dwelling counterparts.Design, Setting, and ParticipantsThis cohort study used the Surveillance, Epidemiology, and End Results database linked with the Medicare database and the Minimum Data Set (including NH clinical assessment data) for deaths occurring from January 1, 2013, to December 31, 2017, among 146 329 older patients with metastatic breast, colorectal, lung, pancreas, or prostate cancer, with a lookback period in claims data through July 1, 2012. Statistical analysis was conducted between March 2021 and September 2022.ExposuresNursing home status.Main Outcomes and MeasuresMarkers of aggressive EOL care were cancer-directed treatment, intensive care unit admission, more than 1 emergency department visit or more than 1 hospitalization in the last 30 days of life, hospice enrollment in the last 3 days of life, and in-hospital death.ResultsThe study population included 146 329 patients 66 years of age or older (mean [SD] age, 78.2 [7.3] years; 51.9% men). Aggressive EOL care was more common among NH residents than community-dwelling residents (63.6% vs 58.3%). Nursing home status was associated with 4% higher odds of receiving aggressive EOL care (adjusted odds ratio [aOR], 1.04 [95% CI, 1.02-1.07]), 6% higher odds of more than 1 hospital admission in the last 30 days of life (aOR, 1.06 [95% CI, 1.02-1.10]), and 61% higher odds of dying in the hospital (aOR, 1.61 [95% CI, 1.57-1.65]). Conversely, NH status was associated with lower odds of receiving cancer-directed treatment (aOR, 0.57 [95% CI, 0.55-0.58]), intensive care unit admission (aOR, 0.82 [95% CI, 0.79-0.84]), or enrollment in hospice in the last 3 days of life (aOR, 0.89 [95% CI, 0.86-0.92]).Conclusions and RelevanceDespite increased emphasis to reduce aggressive EOL care in the past several decades, such care remains common among older persons with metastatic cancer and is slightly more prevalent among NH residents than their community-dwelling counterparts. Multilevel interventions to decrease aggressive EOL care should target the main factors associated with its prevalence, including hospital admissions in the last 30 days of life and in-hospital death.

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Potentially burdensome end‐of‐life transitions among nursing home residents with poor‐prognosis cancer

Lage

DuMontier

Lee

et al. 2019

Cancer

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Background This study examined factors associated with potentially burdensome end‐of‐life (EOL) transitions between care settings among older adults with advanced cancer in nursing homes (NHs). Methods A retrospective analysis of deceased older NH residents with poor‐prognosis solid tumors was conducted with Medicare claims and the Minimum Data Set. A potentially burdensome transition was defined as 2 or more hospitalizations or an intensive care unit admission in the last 90 days of life. Results Among 34,670 subjects, many had moderate to severe cognitive impairment (53.8%), full dependence in activities of daily living (ADLs; 66.5%), and comorbidities such as congestive heart failure (CHF; 29.3%) and chronic obstructive pulmonary disease (34.1%). Only 56.3% of the patients used hospice at any time in the 90 days before death; 36.0% of the patients experienced a potentially burdensome EOL transition, and this was higher among patients who did not receive hospice (45.4% vs 28.7%; P < .01). In multivariable analyses, full dependence in ADLs (odds ratio [OR], 1.70; P < .01), CHF (OR, 1.48; P < .01), and chronic obstructive pulmonary disease (OR, 1.28; P < .01) were associated with a higher risk of burdensome EOL transitions. Those with do‐not‐resuscitate directives (OR, 0.60; P < .01) and impaired cognition (OR, 0.89; P < .01) had lower odds of burdensome EOL transitions. Conclusions NH residents with advanced cancer have substantial comorbidities and functional impairment, yet more than a third experience potentially burdensome EOL transitions. These findings help to identify a population at risk for poor EOL outcomes in order to target interventions, and they point to the importance of advanced care planning in this population.

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Palliative Care Needs of Cancer Patients in U.S. Nursing Homes

Abstract: Our findings suggest important opportunities to improve the quality of cancer care for older adults.

Cited by 66 publications

References 22 publications

End-of-life care for nursing home residents dying from cancer in Nova Scotia, Canada, 2000–2003

End-of-life care for nursing home residents dying from cancer in Nova Scotia, Canada, 2000–2003

Incidence of Aggressive End-of-Life Care Among Older Adults With Metastatic Cancer Living in Nursing Homes and Community Settings

Potentially burdensome end‐of‐life transitions among nursing home residents with poor‐prognosis cancer

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