Intensity of treatment in Swiss cancer patients at the end-of-life

Bähler, Caroline; Signorell, Andri; Blozik, Eva; Reich, Oliver

doi:10.2147/cmar.s156566

Cited by 10 publications

(10 citation statements)

References 50 publications

(90 reference statements)

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“…A recent study reported that 25.6% were still treated tumour specifically within the last 4 weeks of life and 79.1% within the last 3 months [ 10 ]. Bahler et al discovered that in their study cohort, almost 10% of patients started a new chemotherapy regimen in the last 4 weeks of life [ 8 ]. They discussed that palliative late-stage chemotherapy might be evaluated as an option to improve survival, especially in patients who are explicitly seeking further treatment.…”

Section: Discussionmentioning

confidence: 99%

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Would they do it again? Final treatment decisions in malignant brain tumour patients—a caregiver’s perspective

Rapp

Sass

Backhaus

et al. 2022

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Purpose Overall survival of malignant brain tumour patients has significantly been increased over the last years. However, therapy remains palliative, and side effects should be balanced. Once terminal phase is entered, both patients and caregivers may find it hard to accept, and further therapies are demanded. But little is known about this highly sensitive period. Therefore, we analysed the last therapy decisions from the family caregiver’s perspective. Would they support their beloved ones in the same way or would they now recommend a different therapy decision? Methods Caregivers of deceased malignant brain tumour patients, treated at our neurooncological centre between 2011 and 2017, were included. We designed a questionnaire to analyse the impact of the last therapy decision (resection, chemotherapy, radiotherapy), focusing on probable repeat of the choice taken and general therapy satisfaction. Independent variables, for example “satisfaction with therapy”, were analysed using linear regression analysis, the coefficient of determination R2 and the standardized regression coefficient β. The binary logistic regression analyses were taken to illustrate relationships with the dichotomously scaled outcome parameter “re-choice of therapy”. Odds ratio analyses were used to determine the strength of a relationship between two characteristics. Results Data from 102 caregivers (life partners (70.6%)) were analysed retrospectively. Each 40% of patients died in a hospice or at home (20% in a hospital). In 67.6% the last therapy was chemotherapy followed by radiotherapy (16.7%) and surgery (15.7%). A positive evaluation of the last therapy was significantly correlated to re-choosing of respective therapy (chemo-/radiotherapy: p = 0.000) and satisfaction with informed consent (p = 0.000). Satisfaction regarding interpersonal contact was significantly correlated to satisfaction with resection (p = 0.000) and chemotherapy (p = 0.000 27 caregivers (28.7%) felt overburdened with this situation). Conclusion This analysis demonstrates a significant correlation between a positive relation of patient/caregiver/physician and the subjective perception of the latest therapy. It underlines the central role of caregivers, who should be involved in therapy discussions. Neurooncologists should be specially trained in communication and psycho-oncology.

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Section: Discussionmentioning

confidence: 99%

“…Most of the time, the EOL phase treatment is determined by palliative and/or supportive care. But in some cases, patients and their caregivers are explicitly seeking for further treatment options mainly because they are not willing to stop active treatment phase [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Would they do it again? Final treatment decisions in malignant brain tumour patients—a caregiver’s perspective

Rapp

Sass

Backhaus

et al. 2022

Support Care Cancer

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“…Generally, for QIs relating to clinical events, the number of cases tends to be significantly small in a small country such as Switzerland for the comparison of practices, physician networks or regions (QI. [21][22][23][24].…”

Section: Discussionmentioning

confidence: 99%

“…The high quality of the Helsana database has been previously validated, and data were widely used to investigate the aspects of healthcare quality and several patient outcomes. [21][22][23][24] Study subjects were considered eligible for inclusion in the study if they were aged ≥18 years in 2015 and continuously covered by mandatory insurance at the Helsana Group between 1 January 2015 and 31 December 2016. Subjects living abroad, nursing home residents and patients with missing values (eg, incomplete cases) were excluded.…”

Section: Study Population and Settingmentioning

confidence: 99%

Evidence-based quality indicators for primary healthcare in association with the risk of hospitalisation: a population-based cohort study in Switzerland

et al. 2020

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ObjectivesThe quality of ambulatory care in Switzerland is widely unknown. Therefore, this study aimed to evaluate the recently proposed quality indicators (QIs) based on a nationwide healthcare claims database and determine their association with the risk of subsequent hospitalisation at patient-level.DesignRetrospective cohort study.SettingInpatient and outpatient claims data of a large health insurance in Switzerland covering all regions and population strata.Participants520 693 patients continuously insured during 2015 and 2016.MeasuresA total of 24 QIs were obtained by adapting the existing instruments to the Swiss national context and measuring at patient-level. The association between each QI and hospitalisation in the subsequent year was assessed using multiple logistic regression models.ResultsThe proportion of patients with good adherence to QIs was high for the secondary prevention of diabetes and myocardial infarction (glycated haemoglobin (HbA1c) control, 89%; aspirin use, 94%) but relatively low for polypharmacy (53%) or using potentially inappropriate medications (PIMs) in the elderly (PIM, 33%). Diabetes-related indicators such as the HbA1c control were significantly associated with a lower risk of hospitalisation (OR, 0.87; 95% CI, 0.80 to 0.95), whereas the occurrence of polypharmacy and PIM increased the risk of hospitalisation in the following year (OR, 1.57/1.08; 95% CI, 1.51 to 1.64/1.05 to 1.12).ConclusionsThis is the first study to evaluate the recently presented QIs in Switzerland using nationwide real-life data. Our study suggests that the quality of healthcare, as measured by these QIs, varied. The majority of QIs, in particular QIs reflecting chronic care and medication use, are considered beneficial markers of healthcare quality as they were associated with reduced risk of hospitalisation in the subsequent year. Results from this large practical test on real-life data show the feasibility of these QIs and are beneficial in selecting the appropriate QIs for healthcare implementation in general practice.

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“…Recent developments in oncological therapies have offered more options to patients with advanced cancer [1,2]. However, evidence shows that patients are increasingly exposed to aggressive care at the end of life (EOL), leading to poorer outcomes, including decreased quality of life, decreased care satisfaction, more complex bereavement for survivors and increased health care utilization and costs at the EOL [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Association between Consultation by a Comprehensive Integrated Palliative Care Program and Quality of End-of-Life Care in Patients with Advanced Cancer in Edmonton, Canada

et al. 2023

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Literature assessing the impact of palliative care (PC) consultation on aggressive care at the end of life (EOL) within a comprehensive integrated PC program is limited. We retrospectively reviewed patients with advanced cancer who received oncological care at a Canadian tertiary center, died between April 2013 and March 2014, and had access to PC consultation in all healthcare settings. Administrative databases were linked, and medical records reviewed. Composite score for aggressive EOL care was calculated, assigning a point for each of the following: ≥2 emergency room visits, ≥2 hospitalizations, hospitalization >14 days, ICU admission, and chemotherapy administration in the last 30 days of life, and hospital death. Multivariable logistic regression was adjusted for age, sex, income, cancer type and PC consultation for ≥1 aggressive EOL care indicator. Of 1414 eligible patients, 1111 (78.6%) received PC consultation. In multivariable analysis, PC consultation was independently associated with lower odds of ≥1 aggressive EOL care indicator (OR 0.49, 95% CI 0.38–0.65, p < 0.001). PC consultation >3 versus ≤3 months before death had a greater effect on lower aggressive EOL care (mean composite score 0.59 versus 0.88, p < 0.001). We add evidence that PC consultation is associated with less aggressive care at the EOL for patients with advanced cancer.

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Intensity of treatment in Swiss cancer patients at the end-of-life

Cited by 10 publications

References 50 publications

Would they do it again? Final treatment decisions in malignant brain tumour patients—a caregiver’s perspective

Would they do it again? Final treatment decisions in malignant brain tumour patients—a caregiver’s perspective

Evidence-based quality indicators for primary healthcare in association with the risk of hospitalisation: a population-based cohort study in Switzerland

Association between Consultation by a Comprehensive Integrated Palliative Care Program and Quality of End-of-Life Care in Patients with Advanced Cancer in Edmonton, Canada

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