Changes in the place of death for older adults with cancer: Reason to celebrate or a risk for unintended disparities?

Sedhom, Ramy; Kuo, Pei Lun; Gupta, Arjun; Smith, Thomas J.; Chino, Fumiko; Carducci, Michael A.; Bandeen‐Roche, Karen

doi:10.1016/j.jgo.2020.10.008

Cited by 15 publications

(14 citation statements)

References 62 publications

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“…We also observed an increase in the proportion of African Americans dying in the hospital over time, which is consistent with other studies of African American patients with malignancy that have higher shown likelihood of dying in acute care setting [11][12][13]. We would however draw caution in interpreting this finding as inferences on race from the National Inpatient Sample is problematic due to a high proportion of patients with "missing" race in earlier years, and that race is variably and inconsistently reported between states.…”

Section: Discussionsupporting

confidence: 92%

Hospitalization at the end of life in patients with multiple myeloma

et al. 2021

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Background Despite advances in treatment, multiple myeloma (MM) remains incurable and results in significant morbidity and mortality. Further research investigating where MM patients die and characterization of end-of-life hospitalizations is needed. Methods We utilized the National Inpatient Sample (NIS) to explore the hospitalization burden of MM patients at the end of their lives. Results The percent of patients dying in the hospital as a percent of overall MM deaths ranged from 54% in 2002 to 41.4% in 2017 (p < 0.01). Blood transfusions were received in 32.7% of these hospitalizations and infections were present in 47.8% of patients. Palliative care and/or hospice consultations ranged from 5.3% in 2002 to 31.4% in 2017 (p < 0.01). Conclusion Our study demonstrates that patients with MM dying in the hospital have a significant requirement for blood transfusions and have a high infection burden. We also show that palliative care and hospice involvement at the end of life has increased over time but remains low, and that ultimately, inpatient mortality has decreased over time, but MM patients die in the hospital at a higher rate than the general population.

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Section: Discussionsupporting

confidence: 92%

Hospitalization at the end of life in patients with multiple myeloma

et al. 2021

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“…This is consistent with international evidence. 26 Death within public hospital was the highest for blood cancers (leukemia 43% and non-Hodgkin lymphoma 35%), compared with around 20% for all cancers except lung (25%). This is in keeping with other international contexts, wherein most blood cancer deaths occur in hospital.…”

Section: Discussionmentioning

confidence: 98%

“…This is consistent with international evidence. 26 except lung (25%). This is in keeping with other international contexts, wherein most blood cancer deaths occur in hospital.…”

Section: Discussionmentioning

confidence: 99%

Where Are We Dying? Ethnic Differences in Place of Death Among New Zealanders Dying of Cancer

Gurney

Stanley

Koea

et al. 2022

JCO Global Oncology

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PURPOSE Around a third of people with cancer will die outside of their preferred place of death, with substantial variation occurring between and within countries in terms of place of death. Here, we examine place of death within the New Zealand cancer context, with specific focus on differences between Indigenous Māori and other ethnic groups. METHODS Using national-level data, we identified all those who died in New Zealand between 2007 and 2018 of cancer (N = 107,373), stratified by ethnicity and cancer type, and linked these patients to national health and mortality records. We then described the crude and age-standardized proportions of cancer deaths by location separately by ethnic group, and conducted logistic regression to compare odds of death within a given location between ethnic groups. RESULTS After adjusting for age, sex, and deprivation, we found that Māori people with cancer are more likely to die in a private residence than Europeans (46% v 26%; odds ratio [OR] 2.45; 95% CI, 2.36 to 2.55), and also somewhat more likely to die in hospital (27% v 23%; OR 1.26; 95% CI, 1.21 to 1.32). Commensurately, Māori are less likely to die in either hospice inpatient unit (14% v 27%; OR 0.48; 95% CI, 0.45 to 0.51) or residential care (12% v 30%; OR 0.56; 95% CI, 0.52 to 0.59). Pacific patients generally follow the same pattern as Māori patients. These findings were largely repeated across cancer types, with some variation in the magnitude not overall pattern. CONCLUSION It remains unclear whether these differences reflect differences in preferences for place of death between ethnic groups, or whether they reflect differences in access to appropriate supportive care. Further research is required to examine these differences in greater detail.

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“…29 Black patients with cancer are also more likely to die in health care facilities. 30 Thus, we specifically examined contact days at the end of life, where again, Black patients had higher odds of contact days. Higher contact days for Black individuals might represent more uncoordinated care and social determinants of health (eg, limited ability to pay for private help at home etc) that limit what can be done at home, necessitating contact with the health care system (eg, hospitalization).…”

Section: Discussionmentioning

confidence: 99%