Continuity of care and treatment intensity at the end of life in Swiss cancer patients

Abstract

Background: Continuity of care (COC) was shown to be associated with fewer hospitalizations. We aimed to evaluate whether COC was associated with intensive intervention(s) at the end of life (IEOL), a preference-sensitive outcome, in cancer patients.

Methods: The study is based on claims data of patients with incident use of anti-neoplastics in Switzerland. COC Index, Usual Provider Continuity score, Sequential Continuity index and Modified Modified Continuity Index were calculated based on consultations with the usual ambulatory care physician. Treatment intensity was evaluated in the last 6 months of life, and COC was evaluated in months 18-6 before death in those who died between 24 and 54 months after incident cancer. IEOL comprised life-sustaining interventions (cardiac catheterization, cardiac assistance device implantation, pulmonary artery wedge monitoring, cardiopulmonary resuscitation/cardiac conversion, gastrostomy, blood transfusion, dialysis, mechanical ventilator utilization and intravenous antibiotics) and measures specifically used in cancer patients (last dose of chemotherapy ≤14 days of death, a new chemotherapy regimen starting <30 days before death, ≥1 emergency visit in the last month of life, ≥1 hospital admission or spending >14 days in hospital in the last month of life and death in an acute-care hospital).

Results: All COC scores were inversely associated with the occurrence of an IEOL, as were older age, homecare nursing utilization and density of ambulatory care physicians. For COC Index, odds ratio was 0.55 (95% confidence interval 0.37-0.83).

Conclusions: COC scores were consistently and inversely related to IEOL. The study supports efforts to improve COC for cancer patients at their end of life.

Figure 1

Multiple logistic regression model on the occurrence of at least one intensive intervention at the end of life (n = 2055).