Timing of palliative care needs reporting and aggressiveness of care near the end of life in metastatic lung cancer: A national registry‐based study

Goldwasser, François; Vinant, Pascale; Aubry, Régis; Rochigneux, Philippe; Beaussant, Yvan; Huillard, Olivier; Morin, Lucas

doi:10.1002/cncr.31536

Cited by 22 publications

(14 citation statements)

References 39 publications

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“…23,29 A French study in patients who died of metastatic lung cancer showed that end-of-life care was less aggressive the earlier palliative care needs were reported in their EPRs: patients sooner stopped with anticancer treatment and they underwent less often invasive ventilation. 30 In patients with pancreatic cancer in the last 30 days of life who were referred to a palliative care service, those with an early referral to a palliative care team visited the ED less often and were less often hospitalized. 31 It thus seems that when palliative care is integrated into oncology care, patients with ST are at a lower risk of aggressive end-of-life care.…”

Section: Discussionmentioning

confidence: 99%

End-of-Life Trajectories of Patients With Hematological Malignancies and Patients With Advanced Solid Tumors Visiting the Emergency Department: The Need for a Proactive Integrated Care Approach

Verhoef

Nijs

Ootjers

et al. 2019

Am J Hosp Palliat Care

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Purpose: Patients with hematological malignancies (HM) have more unpredictable disease trajectories compared to patients with advanced solid tumors (STs) and miss opportunities for a palliative care approach. They often undergo intensive diseasedirected treatments until the end of life with frequent emergency department (ED) visits and in-hospital deaths. Insight into end-of-life trajectories and quality of end-of-life care can support arranging appropriate care according to patients' wishes. Method: Mortality follow-back study to compare of end-of-life trajectories of HM and ST patients who died <3 months after their ED visit. Five indicators based on Earle et al. for quality of end-of-life care were assessed: intensive anticancer treatment <3 months, ED visits <6 months, in-hospital death, death in the intensive care unit (ICU), and in-hospice death. Results: We included 78 HM patients and 420 ST patients, with a median age of 63 years; 35% had Eastern Cooperative Oncology Group performance status 3-4. At the ED, common symptoms were dyspnea (22%), pain (18%), and fever (11%). After ED visit, 91% of HM patients versus 76% of ST patients were hospitalized (P ¼ .001). Median survival was 17 days (95% confidence interval [CI]: 15-19): 15 days in HM patients (95% CI: 10-20) versus 18 days in ST patients (95% CI: 15-21), P ¼ .028. Compared to ST patients, HM patients more often died in hospital (68% vs 30%, P < .0001) and in the ICU or ED (30% vs 3%, P < .0001). Conclusion: Because end-of-life care is more aggressive in HM patients compared to ST patients, a proactive integrated care approach with early start of palliative care alongside curative care is warranted. Timely discussions with patients and family about advance care planning and end-of-life choices can avoid inappropriate care at the end of life.

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Section: Discussionmentioning

confidence: 99%

End-of-Life Trajectories of Patients With Hematological Malignancies and Patients With Advanced Solid Tumors Visiting the Emergency Department: The Need for a Proactive Integrated Care Approach

Verhoef

Nijs

Ootjers

et al. 2019

Am J Hosp Palliat Care

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“…Another strength of this study is the collection of data from clinical records giving access to the accurate timing of the first intervention of the palliative care team which is not recorded in hospital administrative database [28]. This allowed to describe large variations in the timing of referral to palliative care teams across centres and to analyse the accurate association between this intervention and the indicators of intensity of care.…”

Section: Discussionmentioning

confidence: 99%

Multicentre analysis of intensity of care at the end-of-life in patients with advanced cancer, combining health administrative data with hospital records: variations in practice call for routine quality evaluation

Colombet¹,

Bouleuc²,

Piolot³

et al. 2019

BMC Palliat Care

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Background Accessible indicators of aggressiveness of care at the end-of-life are useful to monitor implementation of early integrated palliative care practice. To determine the intensity of end-of-life care from exhaustive data combining administrative databases and hospital clinical records, to evaluate its variability across hospital facilities and associations with timely introduction of palliative care (PC). Methods For this study designed as a decedent series nested in multicentre cohort of advanced cancer patients, we selected 997 decedents from a cohort of patients hospitalised in 2009–2010, with a diagnosis of metastatic cancer in 3 academic medical centres and 2 comprehensive cancer centres in the Paris area. Hospital data was combined with nationwide mortality databases. Complete data were collected and checked from clinical records, including first referral to PC, chemotherapy within 14 days of death, ≥1 intensive care unit (ICU) admission, ≥2 emergency department visits (ED), and ≥ 2 hospitalizations, all within 30 days of death. Results Overall (min-max) indicator values as reported by facility providing care rather than the place of death, were: 16% (8–25%) patients received chemotherapy within 14 days of death, 16% (6–32%) had ≥2 admissions to acute care, 6% (0–15%) had ≥2 emergency visits and 18% (4–35%) had ≥1 intensive care unit admission(s). Only 53% of these patients met the PC team, and the median (min-max) time between the first intervention of the PC team and death was 41 (17–112) days. The introduction of PC > 30 days before death was independently associated with lower intensity of care. Conclusions Aggressiveness of end-of-life cancer care is highly variable across centres. This validates the use of indicators to monitor integrated PC in oncology. Disseminating a quality audit-feedback cycle should contribute to a shared view of appropriate end-of-life care objectives, and foster action for improvement among care providers.

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“…9,12 In people with cancer, Chronic Obstructive Pulmonary Disease and Chronic Heart Disease, recognition of palliative care needs is associated with better quality of life, contacts with primary care services, more chances to die at home and avoidance of overly aggressive treatment near the end of life including hospital admissions. [13][14][15] The extent to which people with dementia are identified as having palliative care needs, and the benefits of this, are not clear.…”

Section: Introductionmentioning

confidence: 99%

“…We hypothesised that identification of palliative care needs would be associated with fewer hospital admissions close to death, and with a higher number of community palliative care team contacts based on results from previous studies. [13][14][15]…”

Section: Introductionmentioning

confidence: 99%

Identification of palliative care needs among people with dementia and its association with acute hospital care and community service use at the end-of-life: A retrospective cohort study using linked primary, community and secondary care data

Léniz

Higginson

et al. 2021

Palliat Med

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Background: Hospital admissions among people dying with dementia are common. It is not known whether identification of palliative care needs could help prevent unnecessary admissions. Aim: To examine the proportion of people with dementia identified as having palliative care needs in their last year of life, and the association between identification of needs and primary, community and hospital services in the last 90 days. Design: Retrospective cohort study using Discover, an administrative and clinical dataset from 365 primary care practices in London with deterministic individual-level data linkage to community and hospital records. Setting/participants: People diagnosed with dementia and registered with a general practitioner in North West London (UK) who died between 2016 and 2019. The primary outcome was multiple non-elective hospital admissions in the last 90 days of life. Secondary outcomes included contacts with primary and community care providers. We examined the association between identification of palliative care needs with outcomes. Results: Among 5804 decedents with dementia, 1953 (33.6%) were identified as having palliative care needs, including 1141 (19.7%) identified before the last 90 days of life. Identification of palliative care needs before the last 90 days was associated with a lower risk of multiple hospital admissions (Relative Risk 0.70, 95% CI 0.58–0.85) and more contacts with the primary care practice, community nurses and palliative care teams in the last 90 days. Conclusions: Further investigation of the mechanisms underlying the association between identification of palliative care needs and reduced hospital admissions could help reduce reliance on acute care for this population.

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Timing of palliative care needs reporting and aggressiveness of care near the end of life in metastatic lung cancer: A national registry‐based study

Abstract: There is a clear association between the timing of palliative care needs reporting and the aggressiveness of care near the end of life. Cancer 2018;124:3044-51. © 2018 American Cancer Society.

Cited by 22 publications

References 39 publications

End-of-Life Trajectories of Patients With Hematological Malignancies and Patients With Advanced Solid Tumors Visiting the Emergency Department: The Need for a Proactive Integrated Care Approach

End-of-Life Trajectories of Patients With Hematological Malignancies and Patients With Advanced Solid Tumors Visiting the Emergency Department: The Need for a Proactive Integrated Care Approach

Multicentre analysis of intensity of care at the end-of-life in patients with advanced cancer, combining health administrative data with hospital records: variations in practice call for routine quality evaluation

Identification of palliative care needs among people with dementia and its association with acute hospital care and community service use at the end-of-life: A retrospective cohort study using linked primary, community and secondary care data

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