Variations in intensity of end-of-life cancer therapy by cancer type at a Canadian tertiary cancer centre between 2003 and 2010

Abstract

BackgroundAggressive medical management of cancer patients at the end of life (EOL) is an indicator of health services quality. We evaluated the variations in EOL cancer therapy utilization and in acute care hospital deaths across different types of cancer within the setting of a regionalized cancer program.MethodsIntravenous chemotherapy and radiotherapy use within the last 14 and 30 days of life was identified through the Alberta Cancer Registry and then verified by chart review for cancer decedents residing within 50 km of the Tom Baker Cancer Centre between 2003 and 2010. Multivariable logistic regression was used to examine variations in outcomes of interest by cancer, adjusting for age and other factors in prespecified models.ResultsOf the 9863 decedents included in the study, 3.0 and 6.3 % received chemotherapy within the final 14 and 30 days of life, respectively. In multivariable model, breast, hematological, and gynecological cancers were at least 2.5 times more likely than other cancers to undergo EOL chemotherapy. Radiotherapy was given to 4.6 % of decedents within 14 days of death, but only 66 % (359/542 courses) were completed as prescribed. Acute care admission within 14 days of death was seen in 44 % of decedents and 34 % died in the hospital.ConclusionsIn our regional cancer program, the intensity of cancer therapies near the end of life varied considerably across different cancer types. Such variations may be unwarranted. A substantial proportion of cancer deaths occurred in the acute care setting. Greater efforts to integrate palliative care in outpatient cancer services are needed.Electronic supplementary materialThe online version of this article (doi:10.1007/s00520-015-2676-y) contains supplementary material, which is available to authorized users.

Variation in Hospital Utilization at the end of Life for Patients with Cancer in the Emilia-Romagna Region of Italy

“…Approximately half of the patients died in an acute hospital setting. While the sample selections differed, a study in Canada reported 34% of cancer patients dying in the hospital (21). A study of US Medicare beneficiaries age 65 or older reported a reduction in the proportion of cancer patients dying in an acute care hospital from 30% in 2000 to 22% in 2009 (22).…”

Patterns and Yearly Time Trends in the Use of Radiation Therapy During the Last 30 Days of Life Among Patients With Metastatic Rectal Cancer in the United States From 2004 to 2012

“…Previous studies have examined factors associated with RT use in the end of life for patients with rectal cancer. [18][19][20][21][22][23] However, most of these studies evaluated these associations using cohorts consisting of several malignancies including colorectal, lung, breast, and prostate, thus limiting knowledge about cancer-specific trends. This is an important limitation in the current literature since the clinical management of cancer is heterogeneous across disease sites.…”

“…Although several studies have attempted to elucidate factors and trends associated with RT use during the end of life, they have been mostly limited to the Medicare population, thus limiting generalizability to younger populations. [18][19][20][21][22][23] In addition, these studies have not examined RT use during the end of life specifically for patients with rectal cancer. Given the particular clinical management and natural history of a rectal tumor, factors associated with RT use as well as its prevalence in the end-of-life setting may differ for patients with rectal cancer compared to other malignancies.…”

Volumetric changes in pharyngeal structures following head and neck cancer chemoradiation therapy

“…Patients with HNSCC undergo computed tomography (CT) prior to treatment to determine staging and treatment target volumes as well as for posttreatment surveillance purposes. Use of readily available radiation treatment planning software effectively and reliably measures body tissue volumes . Availability of these imaging series collected in a standard treatment and surveillance protocol provides the opportunity to evaluate the three‐dimensional pre‐ and posttreatment tissue volumes in these populations.…”

“…Use of readily available radiation treatment planning software effectively and reliably measures body tissue volumes. 15 Availability of these imaging series collected in a standard treatment and surveillance protocol provides the opportunity to evaluate the three-dimensional pre-and posttreatment tissue volumes in these populations. This retrospective study determined the degree of pharyngeal structure volumetric changes among patients undergoing radical curative CRT for HNSCC.…”