Patterns of End-of-Life Care as Measured by Emergency Room Visits Among Cancer Patients in Puerto Rico

Abstract

Background: Community palliative care (PC) services are scarce in Puerto Rico (PR). Patients with advanced cancer commonly visit the emergency department(ED) at the end of life (EoL). Recognition of patients with limited life expectancies and PC needs may improve the EoL trajectory of these patients. Our objective was to characterize ED visits of cancer patients at the EoL by examining the patterns of ED visits in PR using the PR Central Cancer Registry-Health Insurance Linkage Database (PRCCR-HILD). Methods: The cohort consisted of patients aged ≥18 years with a primary invasive that died between 2011- 2017, with a recorded date of death, and who had insurance claims during their last three months. EoL indicators were ED visits, ED death, and hospice care use. Results: The study cohort included 10,755 cancer patients. 49.6% had ≥1 ED visit, 20.3% had ≥2 ED visits, and 9.7% died in the ED. In the adjusted model, female patients (aOR 0.80; 95% CI 0.68-0.93; p-value < 0.01), patients aged ≥80 years (aOR 0.47; 95% CI 0.36-0.63; p-value < 0.01), being enrolled in Medicare (aOR 0.74; 95% CI 0.61-0.90; p-value < 0.01) or being enrolled in Medicaid/Medicare (aOR 0.76; 95% CI 0.62-0.93; p-value = 0.01) were less likely to have an ED visit the date of death. Patients with distant stage are more likely to have ED ≥ 2visits ( p-value < 0.05). Conclusions: ED visits at EoL can be interpreted as poor quality cancer care and awareness of the potential of ED-initiated PC is needed in PR.

A study of the factors associated with emergency department visits in advanced cancer patients receiving palliative care

“…A Canadian study revealed that 76,759 patients visited the emergency department 194,017 times during their final 6 months of life [7]. Additionally, some studies discovered that between 30.7 and 60% of terminal cancer patients visited an emergency department during their last month of life [8][9][10][11]. According to studies, a variety of factors contribute to people with advanced cancer seeking care in the emergency department, including uncontrolled symptoms (such as uncontrolled pain, dyspnea, fatigue, and confusion) [12], incompetent caregivers, concerns or fear about the disease itself, a sense of security when receiving care in a hospital, and difficulty accessing health care facilities in the community, particularly when symptoms change abruptly or occur outside of normal office hours [13,14].…”

Intranasal Therapy in Palliative Care

“…The number of patients qualified for palliative treatment of various diseases, especially cancer, increases every year [ 18 , 93 ]. Many of them suffer from disseminated disease, with the tumor process often affecting the central nervous system and, as a result, causing brain edema as the disease expands.…”

A study of the factors associated with emergency department visits in advanced cancer patients receiving palliative care

“…(7) Additionally, some studies discovered that between 30.7 and 60% of terminal cancer patients visited an emergency department during their nal month of life. (8)(9)(10)(11) According to studies, a variety of factors contribute to people with advanced cancer seeking care in the emergency department, including uncontrolled symptoms (including uncontrolled pain, dyspnea, fatigue, and confusion), incompetent caregivers, concerns or fear about the disease itself, a sense of security when receiving care in a hospital, and di culty accessing health care facilities in the community, particularly when symptoms change abruptly or occur outside of normal o ce hours. (12,13) Numerous studies have found that the majority of patients visit emergency departments during nonbusiness hours or when community palliative care is unavailable.…”