The aggressiveness of cancer care in the last three months of life: a retrospective single centre analysis

Miranda, Ana; Fonseca, Rute R. da; Passos‐Coelho, José Luís; Fernandes, Aires; Maximino, José; Moreira, A.

doi:10.1002/pon.1140

Cited by 104 publications

(99 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although age is a known determinant of end-of-life care preferences, 8,10 our pooled analysis suggests that age does not fully explain observed differences. Hospice providers may be less available in neighborhoods where Medicaid enrollees reside.…”

Section: Hospice Use By Medicaid Patients With Stage IV Lung Cancermentioning

confidence: 39%

“…[3][4][5] There is no benchmark target rate for hospice use among patients with limited life expectancy. Decreased use among younger patients [8][9][10] and minorities 5-7 may reflect patient preferences. However, lung cancer imposes a considerable symptom burden at the end of life, and the high rate of acute terminal care substantiates this.…”

Section: Hospice Use By Medicaid Patients With Stage IV Lung Cancermentioning

confidence: 99%

“…3, [5][6][7][8][9][10] We evaluated hospice use among Medicaid patients with newly diagnosed stage IV lung cancer in California (CA) and New York (NY) relative to elderly patients in Medicare. Lung cancer is the primary cause of cancer mortality among men and women in the United States.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Underuse of Hospice Care by Medicaid-Insured Patients With Stage IV Lung Cancer in New York and California

Mack

Chen

Boscoe

et al. 2013

JCO

View full text Add to dashboard Cite

Purpose Medicare patients with advanced cancer have low rates of hospice use. We sought to evaluate hospice use among patients in Medicaid, which insures younger and indigent patients, relative to those in Medicare. Patients and Methods Using linked patient-level data from California (CA) and New York (NY) state cancer registries, state Medicaid programs, NY Medicare, and CA Surveillance, Epidemiology, and End Results–Medicare data, we identified 4,797 CA Medicaid patients and 4,001 NY Medicaid patients ages 21 to 64 years, as well as 27,416 CA Medicare patients and 16,496 NY Medicare patients ages ≥ 65 years who were diagnosed with stage IV lung cancer between 2002 and 2006. We evaluated hospice use, timing of enrollment, and location of death (inpatient hospice; long-term care facility or skilled nursing facility; acute care facility; home with hospice; or home without hospice). We used multiple logistic regressions to evaluate clinical and sociodemographic factors associated with hospice use. Results Although 53% (CA) and 44% (NY) of Medicare patients ages ≥ 65 years used hospice, fewer than one third of Medicaid-insured patients ages 21 to 64 years enrolled in hospice after a diagnosis of stage IV lung cancer (CA, 32%; NY, 24%). A minority of Medicaid patient deaths (CA, 19%; NY, 14%) occurred at home with hospice. Most Medicaid patient deaths were either in acute-care facilities (CA, 28%; NY, 36%) or at home without hospice (CA, 39%; NY, 41%). Patient race/ethnicity was not associated with hospice use among Medicaid patients. Conclusion Given low rates of hospice use among Medicaid enrollees and considerable evidence of suffering at the end of life, opportunities to improve palliative care delivery should be prioritized.

show abstract

Section: Hospice Use By Medicaid Patients With Stage IV Lung Cancermentioning

confidence: 39%

Section: Hospice Use By Medicaid Patients With Stage IV Lung Cancermentioning

confidence: 99%

See 1 more Smart Citation

Underuse of Hospice Care by Medicaid-Insured Patients With Stage IV Lung Cancer in New York and California

Mack

Chen

Boscoe

et al. 2013

JCO

View full text Add to dashboard Cite

show abstract

“…Signs of deterioration and side effects should be monitored closely to avoid overtreatment. The incidence of chemotherapy in the last month of life of patients with advanced cancer varies between 11.7 and 37 % [1,[3][4][5][6][7]. The reasons for this overtreatment are many.…”

Section: Introductionmentioning

confidence: 99%

Chemotherapy in the last 30 days of life of advanced cancer patients

Pacetti¹,

Paganini²,

Orlandi³

et al. 2015

Support Care Cancer

View full text Add to dashboard Cite

Twenty-four percent of patients treated with chemotherapy received their last regimen within 1 month of death. Percentage is in line with existing results. It is commonly acknowledged that age, performance status, tumor sensitivity, survival prognosis, and comorbidities should be considered in every chemotherapy decision-making; nevertheless, some studies show that age is not a crucial factor. At present, individual clinician is the only predictor for continuing chemotherapy in the last 4 weeks of life. Although appropriateness criteria were applied, patients were submitted to chemotherapy within 1 month of life; we hope that development of simultaneous care could help in end-life decision-making.

show abstract

“…[1][2][3][4][5][6][7] Previous literature suggests that patients choose to treat incurable cancer for multiple reasons. Inaccurate perceptions of prognosis are one such reason; patients with unrealistic expectations for cure may be more likely to choose aggressive therapies, including cancer treatment, than patients with more realistic expectations.…”

Section: Introductionmentioning

confidence: 99%

Parents’ Views of Cancer-Directed Therapy for Children With No Realistic Chance for Cure

Mack

Joffe

Hilden

et al. 2008

JCO

View full text Add to dashboard Cite

A B S T R A C T PurposePrevious literature suggests that parents often wish to continue cancer-directed therapy for their children with incurable cancer. We assessed parents' experiences with treatment for their children with cancer and no realistic chance of cure. Patients and MethodsWe administered questionnaires to 141 parents of children with cancer who died after receiving care at one of two cancer centers. Parents were asked whether the child benefited and suffered from treatment administered after the parent recognized that cure was not a realistic expectation, and whether they would recommend cancer-directed therapy to other families of children with advanced cancer. ResultsFifty-three (38%) of 141 children received cancer-directed therapy after the parent recognized that the child had no realistic chance for cure. Most of these parents felt that their child had experienced at least some suffering resulting from the therapy (61%, 31 of 51) and little to no benefit (57%, 29 of 51). Fifty-one (38%) of 135 parents overall would recommend standard chemotherapy and 46 (33%) of 140 would recommend experimental chemotherapy to families of children with advanced cancer. Even parents who would not recommend standard chemotherapy generally felt the physician should offer it (91%, 88 of 97). Parents who reported that their children experienced suffering resulting from cancer-directed therapy (odds ratio ϭ 0.46; P ϭ .02) were less likely to recommend standard chemotherapy to other families. ConclusionAlthough many parents choose treatment for their children with incurable cancer, bereaved parents often would not recommend such therapy. Parents who felt their children suffered as a result of cancer treatment were particularly unlikely to recommend it.

show abstract

The aggressiveness of cancer care in the last three months of life: a retrospective single centre analysis

Cited by 104 publications

References 27 publications

Underuse of Hospice Care by Medicaid-Insured Patients With Stage IV Lung Cancer in New York and California

Underuse of Hospice Care by Medicaid-Insured Patients With Stage IV Lung Cancer in New York and California

Chemotherapy in the last 30 days of life of advanced cancer patients

Parents’ Views of Cancer-Directed Therapy for Children With No Realistic Chance for Cure

Contact Info

Product

Resources

About