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. 2022 May 16;21(1):73.
doi: 10.1186/s12904-022-00970-z.

A prospective cohort study assessing aggressive interventions at the end-of-life among patients with solid metastatic cancer

Chetna Malhotra  1   2 , Filipinas Bundoc  3 , Isha Chaudhry  3 , Irene Teo  3   4 , Semra Ozdemir  3   5 , Eric Finkelstein  3   5 ; COMPASS study group
Collaborators, Affiliations

A prospective cohort study assessing aggressive interventions at the end-of-life among patients with solid metastatic cancer

Chetna Malhotra et al. BMC Palliat Care. .

Abstract

Background: Many patients with a solid metastatic cancer are treated aggressively during their last month of life. Using data from a large prospective cohort study of patients with an advanced cancer, we aimed to assess the number and predictors of aggressive interventions during last month of life among patients with solid metastatic cancer and its association with bereaved caregivers' outcomes.

Methods: We used data of 345 deceased patients from a prospective cohort study of 600 patients. We surveyed patients every 3 months until death for their physical, psychological and functional health, end-of-life care preference and palliative care use. We surveyed their bereaved caregivers 8 weeks after patients' death regarding their preparedness about patient's death, regret about patient's end-of-life care and mood over the last week. Patient data was merged with medical records to assess aggressive interventions received including hospital death and use of anti-cancer treatment, more than 14 days in hospital, more than one hospital admission, more than one emergency room visit and at least one intensive care unit admission, all within the last month of life.

Results: 69% of patients received at least one aggressive intervention during last month of life. Patients hospitalized during the last 2-12 months of life, male patients, Buddhist or Taoist, and with breast or respiratory cancer received more aggressive interventions in last month of life. Patients with worse functional health prior to their last month of life received fewer aggressive interventions in last month of life. Bereaved caregivers of patients receiving more aggressive interventions reported feeling less prepared for patients' death.

Conclusion: Findings suggest that intervening early in the sub-group of patients with history of hospitalization prior to their last month may reduce number of aggressive interventions during last month of life and ultimately positively influence caregivers' preparedness for death during the bereavement phase.

Trial registration: NCT02850640 .

Keywords: Advanced cancer; Aggressive interventions; End-of-life care; Palliative care.

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Conflict of interest statement

The authors declare that they have no competing interests

Figures

Fig. 1
Fig. 1
Aggressive interventions received by patients during their last month of life (N = 345). * Denominator for proportion of hospital death is 298
See this image and copyright information in PMC

References

    1. Hu W, Yasui Y, White J, Winget M. Aggressiveness of end-of-life Care for Patients with Colorectal Cancer in Alberta, Canada: 2006–2009. J Pain Symptom Manag. 2014;47(2):231–244. doi: 10.1016/j.jpainsymman.2013.03.021. - DOI - PubMed
    1. Kao Y-H, Chiang J-K. Effect of hospice care on quality indicators of end-of-life care among patients with liver cancer: a national longitudinal population-based study in Taiwan 2000–2011. BMC Palliative Care. 2015;14(1):39. doi: 10.1186/s12904-015-0036-9. - DOI - PMC - PubMed
    1. Presley CJ, Han L, O'Leary JR, Zhu W, Corneau E, Chao H, Shamas T, Rose M, Lorenz K, Levy CR, Mor V, Gross CP. Concurrent hospice care and Cancer-directed treatment for advanced lung Cancer and receipt of aggressive Care at the end of life in the Veteran's health administration. J Palliat Med. 2020;23(8):1038–1044. doi: 10.1089/jpm.2019.0485. - DOI - PMC - PubMed
    1. Hui D, Kim SH, Roquemore J, Dev R, Chisholm G, Bruera E. Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients. Cancer. 2014;120(11):1743–1749. doi: 10.1002/cncr.28628. - DOI - PMC - PubMed
    1. Boddaert MS, Pereira C, Adema J, Vissers KC, van der Linden YM, Raijmakers NJ, et al. Inappropriate end-of-life cancer care in a generalist and specialist palliative care model: a nationwide retrospective population-based observational study. BMJ Support Palliat Care. 2020. - PMC - PubMed

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