Quality of End-of-Life Cancer Care in Canada: A Retrospective Four-Province Study Using Administrative Health Care Data

Barbera, Lisa; Seow, Hsien; Sutradhar, Rinku; Chu, Anna; Fassbender, Konrad; McGrail, Kim; Lawson, Beverley; Liu, Y.; Pataky, Reka; Potapov, Alexey

doi:10.3747/co.22.2636

Cited by 45 publications

(56 citation statements)

References 33 publications

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“…In England, about 46.7% of all deaths occur in hospital (2015 data) with a decrease of 11.2% in 10 years, while in the United States, 28.8% of deaths occurred in hospital for EOL cancer patients in 2003 with a 14.4% decrease in 7 years . Higher rates of cancer patients dying in a hospital are also observed in Canada, where on average 54% patients died in hospital . Location of death not only influences the dying experience but also affects healthcare utilization and costs .…”

Section: Introductionmentioning

confidence: 99%

Performance of care for end‐of‐life cancer patients in Tuscany: The interplay between place of care, aggressive treatments, opioids, and place of death. A retrospective cohort study

Ferrè

Vinci

Murante

2019

Health Planning & Management

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Summary Supportive and palliative care at the end of life (EOL) is a core component of health systems. Providing care at the EOL may require the interaction of several care providers working in different settings including nursing homes, home care, hospices, and hospitals. This work aims to (a) provide evidence on the performance of EOL care for cancer patients across healthcare organizations, with a focus on the place of care, aggressive treatments, opioids, and the place of death and (b) analyze factors associated with dying in hospital. A population‐based retrospective study was performed using administrative data from Tuscany region (Italy). Thirteen thousand sixty‐six cancer patients who died in 2016 were considered. There is a marked variability in EOL care within regional areas, with the multilevel logistic regression highlighting a greater likelihood of dying in hospital for patients who were admitted to intensive care units or previously hospitalized. There is a lower probability of dying in acute care setting for patients assisted in hospices and in both hospital and hospices/home care and for patients treated with opioids. This intraregional variation highlights the need to improve EOL planning and rethink the delivery of supportive/palliative care. Further investigations on the preferences of patients may lead to more understanding.

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Section: Introductionmentioning

confidence: 99%

Performance of care for end‐of‐life cancer patients in Tuscany: The interplay between place of care, aggressive treatments, opioids, and place of death. A retrospective cohort study

Ferrè

Vinci

Murante

2019

Health Planning & Management

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“…Those outcomes were selected because, in prior studies, a shorter interval from diagnosis to death [16][17][18][19]22,23 and in-hospital death 18,20,21 were indicators of lower rates of access to out-of-hospital palliative support. Other outcome indicators of the quality of community-based palliative care at end of life are timely enrolment in specialized palliative care 16,20,23 , no or few days in hospital in the last month of life 18,22 , and minimal use of the emergency department [18][19][20][21][22] . Receiving palliative radiation [16][17][18][19][20]23 and home care [20][21][22] have also been used as indicators of quality end-of-life care.…”

Section: Strengths Limitations and Recommendationsmentioning

confidence: 99%

“…Receiving palliative radiation [16][17][18][19][20]23 and home care [20][21][22] have also been used as indicators of quality end-of-life care. Access to, and continuity of, primary care, the use of medical oncology and chemotherapy [18][19][20]22 , and being a nursing home resident 19,23,30 are also relevant. Socioeconomic and distance indicators of inequity should be investigated by linking the postal code of residence at death to census data 17,19,22,23,45 because a meta-analysis showed that the benefit from navigation is greatest for the most vulnerable individuals 46 .…”

Section: Strengths Limitations and Recommendationsmentioning

confidence: 99%

“…Other outcome indicators of the quality of community-based palliative care at end of life are timely enrolment in specialized palliative care 16,20,23 , no or few days in hospital in the last month of life 18,22 , and minimal use of the emergency department [18][19][20][21][22] . Receiving palliative radiation [16][17][18][19][20]23 and home care [20][21][22] have also been used as indicators of quality end-of-life care. Access to, and continuity of, primary care, the use of medical oncology and chemotherapy [18][19][20]22 , and being a nursing home resident 19,23,30 are also relevant.…”

Section: Strengths Limitations and Recommendationsmentioning

confidence: 99%

“…Although few studies of navigation in relation to palliative and end-of-life care have been reported 5,8 , the population-based study design for investigating care for people at the end of life has been well established in Nova Scotia and elsewhere [16][17][18][19][20][21][22][23] . Nova Scotia is therefore an ideal setting to investigate use of navigation by people with cancer who are in their last phase of life.…”

Section: Introductionmentioning

confidence: 99%

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Comparing Enrolees with Non-Enrolees of Cancer-Patient Navigation at End of Life

Park¹,

Johnston

Urquhart³

et al. 2018

Current Oncology

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Timing of Palliative Care, End-of-Life Quality Indicators, and Health Resource Utilization

Mah,

Carter Ramirez,

Schnarr

et al. 2024

JAMA Netw Open

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ImportanceDespite research supporting the benefits of early palliative care, timely initiation by gynecologic oncology patients is reportedly low, which may limit the effectiveness of palliative care.ObjectiveTo investigate the association of the timing of palliative care initiation with the aggressiveness of end-of-life care using established quality indicators among patients with ovarian cancer.Design, Setting, and ParticipantsThis population-based retrospective cohort study of ovarian cancer decedents used linked administrative health care data to identify palliative care provision across all health care sectors and health care professionals (specialist and nonspecialist) and end-of-life quality indicators in Ontario, Canada, from 2006 to 2018. Data analyses were performed July 12, 2024.Main Outcomes and MeasuresThe primary outcome was the associations between the timing of palliative care and end-of-life quality indicators, including emergency department use, hospital or intensive care unit admission in the last 30 days of life, chemotherapy in last 14 days of life, death in the hospital, and a composite measure of aggressive care. Late palliative care was defined as 3 months or less prior to death.ResultsThere were 8297 ovarian cancer decedents. Their mean (SD) age at death was 69.6 (13.1) years, and their mean (SD) oncologic survival was 2.8 (3.9) years. Among 3958 patients with known cancer stage, 3495 (88.3%) presented with stage III or IV disease. One-third of patients (2667 [32.1%]) received late palliative care in the final 3 months of life. Results of multivariable regression analysis indicated that any palliative care initiated earlier than 3 months before death was associated with lower rates of aggressive end-of-life care (odds ratio [OR], 0.47 [95% CI, 0.37-0.60]), death in hospital (OR, 0.54 [95% CI, 0.45-0.65]), and intensive care unit admission (OR, 0.46 [95% CI, 0.27-0.76]). Specialist palliative consultation from 3 months up to 6 monts before death was associated with decreased likelihood of late chemotherapy (OR, 0.46 [95% CI, 0.24-0.88]).ConclusionsFindings from this cohort study suggested that early palliative care may be associated with less-aggressive end-of-life care than late palliative care. Implementation strategies for early palliative care initiation are needed to optimize care quality and health resource utilization at the end of life.

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Quality of End-of-Life Cancer Care in Canada: A Retrospective Four-Province Study Using Administrative Health Care Data

Abstract: BackgroundThe quality of data comparing care at the end of life (eol) in cancer patients across Canada is poor.

Cited by 45 publications

References 33 publications

Performance of care for end‐of‐life cancer patients in Tuscany: The interplay between place of care, aggressive treatments, opioids, and place of death. A retrospective cohort study

Performance of care for end‐of‐life cancer patients in Tuscany: The interplay between place of care, aggressive treatments, opioids, and place of death. A retrospective cohort study

Comparing Enrolees with Non-Enrolees of Cancer-Patient Navigation at End of Life

Timing of Palliative Care, End-of-Life Quality Indicators, and Health Resource Utilization

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