Anxiety, depression, and end‐of‐life care utilization in adults with metastatic cancer

Abstract

Objective End‐of‐life care for patients with cancer is often overly burdensome, and palliative and hospice care are underutilized. The objective of this study was to evaluate whether the mental health diagnoses of anxiety and depression were associated with variation in end‐of‐life care in metastatic cancer. Methods This study used electronic health data from 1,333 adults with metastatic cancer who received care at two academic health centers in Louisiana, USA, and died between 1/1/2011–12/31/2017. The study used descriptive statistics to characterize the sample and logistic regression to examine whether anxiety and depression diagnoses in the six months before death were associated with utilization outcomes (chemotherapy, intensive care unit [ICU] visits, emergency department visits, mechanical ventilation, inpatient hospitalization, palliative care encounters, and hospice utilization), while controlling for key demographic and health covariates. Results Patients (56.1% male; 65.6% White, 31.1% Black) commonly experienced depression (23.9%) and anxiety (27.2%) disorders within six months of death. Anxiety was associated with an increased likelihood of chemotherapy (odds ratio [OR] = 1.42, p = 0.016), ICU visits (OR = 1.40, p = 0.013), and inpatient hospitalizations (OR = 1.85, p < 0.001) in the 30 days before death. Anxiety (OR = 1.95, p < 0.001) and depression (OR = 1.34, p = 0.038) were associated with a greater likelihood of a palliative encounter. Conclusions Patients with metastatic cancer who had an anxiety disorder were more likely to have burdensome end‐of‐life care, including chemotherapy, ICU visits, and inpatient hospitalizations in the 30 days before death. Depression and anxiety both increased the odds of palliative encounters. These results emphasize the importance of mental health considerations in end‐of‐life care.

Palliative oncology and palliative care

“…Rational treatment decisions are also desirable, but a person facing his or her impending death is not rational but in a state of emotional turmoil [ 39 , 41 , 46 , 47 ]. Anxiety, especially in the form of death anxiety, is a strong driving force for treatment requests [ 39 , 41 , 48 ], and it is associated with an increased likelihood of continuing chemotherapy even in the 30 days before death [ 49 , 50 ]. Nevertheless, palliative chemotherapy during the last weeks of life is not associated with improved quality of life.…”

Systemic oncological treatments in patients with advanced pancreatic cancer: a scoping review and evidence map

“…There is increasing recognition of the need to prioritise patient-centred communication and to have a focus on the patients’ goals of care [ 5 ]. For patients with advanced PC with a poor prognosis, these goals inevitably vary and may not necessarily be related only to an increase in survival [ 5 ]. Based on the results of our study, these other goals of care are not sufficiently reported.…”

“…Therefore, patients with advanced PC have a high risk of dying in the short or medium term, which is conceptualised as the ‘end of life’ (EoL) period [ 3 ]. Deciding the most appropriate treatment for patients with advanced PC at the EoL should be based on the best available evidence and considering patient’s values and preferences, since failing to do so could increase patients’ psychological distress and the overutilisation of treatments that may be inconsistent with personal preferences [ 4 , 5 ].…”

Demand and Countermeasures for an “Internet + Nursing” Service for Elderly Patients with Chronic Diseases in Northeast China

“…(2) The need for hospice nursing Patients with chronic diseases are di cult to cure by drugs, so they will inevitably die [16] . When a patient approaches death, he/she often suffers from anxiety and depression, so mental health counseling plays an important role in hospice nursing [17] .…”