Trends in quality indicators of end-of-life care for women with gynecologic malignancies in Ontario, Canada

Mah, Sarah J.; Seow, Hsien; Schnarr, Kara; Reade, Clare J.; Gayowsky, Anastasia; Chan, Kelvin K.; Sinnarajah, Aynharan

doi:10.1016/j.ygyno.2022.09.008

Cited by 4 publications

(2 citation statements)

References 51 publications

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“…The same relationship, however, may not appear for females, who, despite education level, may have lower incomes due to the longstanding gender wage gap in addition to traditional gender norms driving increased caregiver responsibilities and less income-generating work outside the home [42,43]. Other studies showed an association between increased risk of aggressive EOL care and lower income [16,[44][45][46], though, to our knowledge, this is the first study to directly compare how income may affect the aggressiveness of care for each sex.…”

Section: Discussionmentioning

confidence: 99%

Sex-Based Analysis of Quality Indicators of End-of-Life Care in Gastrointestinal Malignancies

Lees,

Seow,

Chan

et al. 2024

Current Oncology

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Indices of aggressive or supportive end-of-life (EOL) care are used to evaluate health services quality. Disparities according to sex were previously described, with studies showing that male sex is associated with aggressive EOL care. This is a secondary analysis of 69,983 patients who died of a GI malignancy in Ontario between 2006 and 2018. Quality indices from the last 14–30 days of life and aggregate measures for aggressive and supportive EOL care were derived from administrative data. Hospitalizations, emergency department use, intensive care unit admissions, and receipt of chemotherapy were considered indices of aggressive care, while physician house call and palliative home care were considered indices of supportive care. Overall, a smaller proportion of females experienced aggressive care at EOL (14.3% vs. 19.0%, standardized difference = 0.13, where ≥0.1 is a meaningful difference). Over time, rates of aggressive care were stable, while rates of supportive care increased for both sexes. Logistic regression showed that younger females (ages 18–39) had increased odds of experiencing aggressive EOL care (OR 1.71, 95% CI 1.30–2.25), but there was no such association for males. Quality of EOL care varies according to sex, with a smaller proportion of females experiencing aggressive EOL care.

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Section: Discussionmentioning

confidence: 99%

Sex-Based Analysis of Quality Indicators of End-of-Life Care in Gastrointestinal Malignancies

Lees,

Seow,

Chan

et al. 2024

Current Oncology

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“…Most of our population received some type of palliative care in the last year of life ( n = 65,076, 93.0%), and most received a palliative care homecare service in the last 30 days of life ( n = 45,327, 70.0%). The use of supportive care in the last 30 days of life is comparable to other specific cancers, such as 82.1% in multiple myeloma and 69.8% in gynecologic cancers; though these are historically cancers with lower rates of palliative care utilization at end of life [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Quality of End-of-Life Care in Gastrointestinal Cancers: A 13-Year Population-Based Retrospective Analysis in Ontario, Canada

et al. 2022

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Population-based quality indicators of either aggressive or supportive care at end of life (EOL), especially when specific to a cancer type, help to inform quality improvement efforts. This is a population-based, retrospective cohort study of gastrointestinal (GI) cancer decedents in Ontario from 1 January 2006–31 December 2018, using administrative data. Quality indices included hospitalizations, emergency department (ED) use, intensive care unit admissions, receipt of chemotherapy, physician house call, and palliative home care in the last 14–30 days of life. Previously defined aggregate measures of both aggressive and supportive care at end of life were also used. In our population of 69,983 patients who died of a GI malignancy during the study period, the odds of experiencing aggressive care at EOL remained stable, while the odds of experiencing supportive care at EOL increased. Most of our population received palliative care in the last year of life (n = 65,076, 93.0%) and a palliative care home care service in the last 30 days of life (n = 45,327, 70.0%). A significant number of patients also experienced death in an acute care hospital bed (n = 28,721, 41.0%) or had a new hospitalisation in the last 30 days of life (n = 33,283, 51.4%). The majority of patients received palliative care in the last year of life, and a majority received a palliative care home service within the last 30 days of life. The odds of receiving supportive care at EOL have increased over time. Differences in care exist according to income, age, and rurality.

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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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Trends in quality indicators of end-of-life care for women with gynecologic malignancies in Ontario, Canada

Cited by 4 publications

References 51 publications

Sex-Based Analysis of Quality Indicators of End-of-Life Care in Gastrointestinal Malignancies

Sex-Based Analysis of Quality Indicators of End-of-Life Care in Gastrointestinal Malignancies

Quality of End-of-Life Care in Gastrointestinal Cancers: A 13-Year Population-Based Retrospective Analysis in Ontario, Canada

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

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