Quality of end‐of‐life care in patients with hematologic malignancies: A retrospective cohort study

Hui, David; Didwaniya, Neha; Vidal, Marieberta; Shin, Seong Hoon; Chisholm, Gary B.; Roquemore, Joyce; Bruera, Éduardo

doi:10.1002/cncr.28614

Cited by 261 publications

(293 citation statements)

References 29 publications

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“…For example, lack of access for rural residents to community-based services after clinical hours likely increases reliance on hospital care. That finding is supported by numerous studies [13][14][15] . Further work is needed to better understand the landscape of end-of-life care in Canada:…”

Section: Resultssupporting

confidence: 78%

Acute Care Hospitalization Near the End of Life for Cancer Patients Who Die in Hospital in Canada

et al. 2017

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Acute care hospitals have a role in managing the health care needs of people affected by cancer when they are at the end of life. However, there is a need to provide end-of-life care in other settings, including at home or in hospice, when such settings are more appropriate. Using data from 9 provinces, we examined indicators that describe the current landscape of acute care hospital use at the end of life for patients who died of cancer in hospital in Canada.Interprovincial variation was observed in acute care hospital deaths, length of stay in hospital, readmission to hospital, and intensive care unit use at the end of life. High rates of acute care hospital use near the end of life might suggest that community and home-based end-of-life care might not be suiting patient needs.

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Section: Resultssupporting

confidence: 78%

Acute Care Hospitalization Near the End of Life for Cancer Patients Who Die in Hospital in Canada

et al. 2017

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“…We found that hematologic oncology specialists expressed lower comfort levels compared with their solid tumor counterparts.This is consistent with multiple studies demonstrating that hematologic oncologists were generally less comfortable with EOL care [13,14] and that patients with advanced hematologic malignancies often have lower access to acute palliative are and hospice care and more intensive EOL care [12,20]. This difference might be related to challenges in prognostication, difficulty in identifying the EOL period, the plethora of novel treatment options with curative potential, and patient preferences [13].…”

Section: Discussionsupporting

confidence: 81%

Impact of Oncologists’ Attitudes Toward End-of-Life Care on Patients’ Access to Palliative Care

et al. 2016

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Background. It is unclear how oncologists' attitudes toward end-of-life (EOL) care affect the delivery of care. The present study examined the association between oncologists' EOL care attitudes and (a) timely specialist palliative care referral, (b) provision of supportive care, and (c) EOL cancer treatment decisions. Methods. We randomly surveyed 240 oncology specialists at our tertiary care cancer center to assess their attitudes toward EOL care using a score derived from the Jackson et al. qualitative conceptual framework (0 5 uncomfortable and 8 5 highly comfortable with EOL care). We determined the association between this score and clinicians' report of specialist palliative care referral, provision of supportive care, and EOL cancer treatment decisions. Results. Of the 182 respondents (response rate of 76%), the median composite EOL care score was 6 (interquartile range,

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“…The three cancer subgroups were metastatic germ cell tumors and prostate cancer; metastatic lung, liver, and pancreatic cancer; and all other metastatic cancers. Patients with hematologic malignancies were excluded because it was previously reported that these patients tended to receive more aggressive EOL care [21].…”

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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Quality of end‐of‐life care in patients with hematologic malignancies: A retrospective cohort study

Cited by 261 publications

References 29 publications

Acute Care Hospitalization Near the End of Life for Cancer Patients Who Die in Hospital in Canada

Acute Care Hospitalization Near the End of Life for Cancer Patients Who Die in Hospital in Canada

Impact of Oncologists’ Attitudes Toward End-of-Life Care on Patients’ Access to Palliative Care

Palliative Chemotherapy Affects Aggressiveness of End-of-Life Care

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