Top

Published in:

Open Access 01-03-2018 | Original Article

How do treatment aims in the last phase of life relate to hospitalizations and hospital mortality? A mortality follow-back study of Dutch patients with five types of cancer

Authors: Mariska Oosterveld-Vlug, Gé Donker, Femke Atsma, Linda Brom, Yvonne de Man, Stef Groenewoud, Bregje Onwuteaka-Philipsen

Published in: Supportive Care in Cancer | Issue 3/2018

Abstract

Purpose

The purpose of this study is to describe and compare the relation between treatment aims, hospitalizations, and hospital mortality for Dutch patients who died from lung, colorectal, breast, prostate, or pancreatic cancer.

Methods

A mortality follow-back study was conducted within a sentinel network of Dutch general practitioners (GPs), who recorded the end-of-life care of 691 patients who died from one of the abovementioned cancer types between 2009 and 2015. Differences in care by type of cancer were analyzed using multilevel analyses to control for clustering within general practices.

Results

Among all cancer types, patients with prostate cancer most often and patients with pancreatic cancer least often had a palliative treatment aim a month before death (95% resp. 84%). Prostate cancer patients were also least often admitted to hospital in the last month of life (18.5%) and least often died there (3.1%), whereas lung cancer patients were at the other end of the spectrum with 41.8% of them being admitted to hospital and 22.6% dying in hospital. Having a palliative treatment aim and being older were significantly associated with less hospital admissions, and having a palliative treatment aim, having prostate cancer, and dying in a more recent year were significantly associated with less hospital deaths.

Conclusion

There is large variation between patients with different cancer types with regard to treatment aims, hospital admissions, and hospital deaths. The results highlight the need for early initiation of GP palliative care to support patients from all cancer types to stay at the place they prefer as long as possible.

Available only for authorised users

Higginson IJ, Sen-Gupta GJA (2000) Place of care in advanced cancer: a qualitative systematic review literature review of patient preferences. J Palliat Med 3:287–300. https://doi.org/10.1089/jpm.2000.3.287 CrossRefPubMed

Gomes B, Calanzani N, Gysels M, Hall S, Higginson IJ (2013) Heterogeneity and changes in preferences for dying at home: a systematic review. BMC Palliat Care 12:7. https://doi.org/10.1186/1472-684X-12-7 CrossRefPubMedPubMedCentral

Ko W, Beccaro M, Miccinesi G, Van Casteren V, Donker GA, Onwuteaka-Philipsen B, Miralles Espi MT, Deliens L, Costantini M, Van den Block L (2013) Awareness of general practitioners concerning cancer patients’ preferences for place of death: evidence from four European countries. Eur J Cancer 49:1967–1974. https://doi.org/10.1016/j.ejca.2013.01.006 CrossRefPubMed

Earle CC, Park ER, Lai B, Weeks JC, Ayanian JZ, Block S (2013) Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol 21:1133–1138. https://doi.org/10.1200/JCO.2003.03.059 CrossRef

De Roo ML, Miccinesi G, Onwuteaka-Philipsen BD, Van den Noortgate N, Van den Block L, Bonacchi A, Donker GA, Lozano Alonso JE, Moreels S, Deliens L, Francke AL (2014) Actual and preferred place of death of home-dwelling patients in four European countries: making sense of quality indicators. PLoS One 9:e93762. https://doi.org/10.1371/journal.pone.0093762 CrossRefPubMedPubMedCentral

Janssens RJPA, Ten Have HAMJ (2001) The concept of palliative care in the Netherlands. Palliat Med 15:481–486. https://doi.org/10.1191/026921601682553969 CrossRefPubMed

Evans N, Costantini M, Pasman HRW, Van den Block L, Donker GA, Miccinesi G, Bertolissi S, Gil M, Boffin N, Zurriaga O, Deliens L, Onwuteaka-Philipsen B (2014a) End-of-life communication: a retrospective survey of representative GP networks in four countries. J Pain Symptom Manag 47:604–619. https://doi.org/10.1016/j.jpainsymman.2013.04.008 CrossRef

Brinkman-Stoppelenburg A, Onwuteaka-Philipsen BD, van der Heide A (2015) Involvement of supportive care professionals in patient care in the last month of life. Support Care Cancer 23:2899–2906. https://doi.org/10.1007/s00520-015-2655-3 CrossRefPubMedPubMedCentral

Abarshi E, Echteld M, Van den Block L, Donker G, Deliens L, Onwuteaka-Philipsen B (2010a) Transitions between care settings at the end of life in the Netherlands: results from a nationwide study. Palliat Med 24:166–174. https://doi.org/10.1177/0269216309351381 CrossRefPubMed

10.

McKinley RK, Stokes T, Exley C, Field D (2004) Care of people dying with malignant and cardiorespiratory disease in general practice. Br J Gen Pract 54:909–913PubMedPubMedCentral

11.

Beernaert K, Cohen C, Deliens L, Devroey D, Vanthomme K, Pardon K, Van den Block L (2013) Referral to palliative care in COPD and other chronic diseases: a population-based study. Respir Med 107:1731–1739. https://doi.org/10.1016/j.rmed.2013.06.003 CrossRefPubMed

12.

Pivodic L, Pardon K, Van den Block L, Van Casteren V, Miccinesi G, Donker GA, Alonso TV, Alonso JL, Aprile PL, Onwuteaka-Philipsen DL (2013) Palliative care service use in four European countries: a cross-national retrospective study via representative networks of general practitioners. PLoS One 8:e84440. https://doi.org/10.1371/journal.pone.0084440 CrossRefPubMedPubMedCentral

13.

Evans N, Pasman HRW, Donker GA, Deliens L, Van den Block L, Onwuteaka-Philipsen B (2014b) End-of-life care in general practice: a cross-sectional, retrospective survey of ‘cancer’, ‘organ failure’ and ‘old-age/dementia’ patients. Palliat Med 28:965–975. https://doi.org/10.1177/0269216314526271 CrossRefPubMed

14.

Ahmed N, Bestall JC, Ahmedzai SH, Payne SA, Clark D, Noble B (2004) Systematic review of the problems and issues of accessing specialist palliative care by patients, carers and health and social care professionals. Palliat Med 18:525–542. https://doi.org/10.1191/0269216304pm921oa CrossRefPubMed

15.

Exley C, Field D, Jones L, Stokes T (2005) Palliative care in the community for cancer and end-stage cardiorespiratory disease: the views of patients, lay-carers and health care professionals. Palliat Med 19:76–83. https://doi.org/10.1191/0269216305pm973oa CrossRefPubMed

16.

Claessen SJJ, Francke AL, Echteld MA, Schweitzer BPM, Donker GA, Deliens L (2013a) GPs’ recognition of death in the foreseeable future and diagnosis of a fatal condition: a national survey. BMC Fam Pract 14:104. https://doi.org/10.1186/1471-2296-14-104 CrossRefPubMedPubMedCentral

17.

Claessen SJJ, Francke AL, Engels Y, Deliens L (2013b) How do GPs identify a need for palliative care in their patients? An interview study. BMC Fam Pract 14:1–7. https://doi.org/10.1186/1471-2296-14-42 CrossRef

18.

IKNL [Netherlands Comprehensive Cancer Center], Cijfers over kanker-Overleving kanker totaal [Statistics on cancer-survival all cancers] (2017) Available: http://www.cijfersoverkanker.nl/selecties/overleving_kanker_totaal/img581754eaabd52. Accessed: 2–3-2017

19.

Lunney JR, Lynn J, Foley DJ, Lipson S, Guralnik JM (2003) Patterns of functional decline at the end of life. JAMA 289:2387–2392CrossRefPubMed

20.

Murray SA, Kendall M, Boyd K, Sheikh A (2005) Illness trajectories and palliative care. BMJ 330:1007–1011. https://doi.org/10.1136/bmj.330.7498.1007 CrossRefPubMedPubMedCentral

21.

Costantini M, Beccaro M, Higginson IJ (2008) Cancer trajectories at the end of life: is there an effect of age and gender? BMC Cancer 8:127. https://doi.org/10.1186/1471-2407-8-127 CrossRefPubMedPubMedCentral

22.

Eurostat Health Statistics (Causes of death) (2013) Available: http://ec.europa.eu/eurostat/documents/2995521/7149996/3-03022016-BP-EN.pdf/0bbc3389-8c0d-44a0-9b0c-2a0bff49f466. Accessed: 2-3-2017

23.

Donker GA (2014) NIVEL primary care database—sentinel practices, 2014. Nivel, Utrecht Available: http://www.nivel.nl/sites/default/files/bestanden/Peilstations_2014_Engels.pdf

24.

Dutch Government (2016) Wet bescherming persoonsgegevens [Dutch Personal Data Protection Act]. Available: http://wetten.overheid.nl/BWBR0011468/2016-01-01. Accessed: 2-3-2017

25.

Bernards N, Mohammad NH, Creemers G, De Hingh IHJT, Van Laarhoven HW, Lemmens VEPP (2015) Ten weeks to live: a population-based study on treatment and survival of patients with metastatic pancreatic cancer in the south of the Netherlands. Acta Oncol 54:403–410. https://doi.org/10.3109/0284186X.2014.953257 CrossRefPubMed

26.

Abarshi E, Echteld MA, Van den Block L, Donker GA, Deliens L, Onwuteaka-Philipsen B (2010b) The oldest old and GP end-of-life care in the Dutch community: a nationwide study. Age Ageing 39:716–722. https://doi.org/10.1093/ageing/afq097 CrossRefPubMed

27.

Beernaert K, Deliens L, Pardon K, Van den Block L, Devroey D, Chambaere K, Cohen J (2015) What are physicians’ reasons for not referring people with life-limiting illnesses to specialist palliative care services? A nationwide survey. PLoS One 10:e0137251. https://doi.org/10.1371/journal.pone.0137251 CrossRefPubMedPubMedCentral

28.

Statistics Netherlands (2014) CBS statline Ziekenhuisopnamen; geslacht, leeftijd en diagnose-indeling. [Hospital admissions; gender, age and diagnosis]. Via http://bit.ly/2lZLJnH. Accessed 2-3-2017

29.

Bekelman JE, Halpern SD, Blankart CR, Bynum JP, Cohen J, Fowler R, Kaasa S, Kwietniewski L, Melberg HO, Onwuteaka-Philipsen B, Oosterveld-Vlug M, Pring A, Schreyögg J, Ulrich CM, Verne J, Wunsch H, Emanuel EJ (2016) Comparison of site of death, health care utilization, and hospital expenditures for patients dying with cancer in 7 developed countries. JAMA 315:272–283. https://doi.org/10.1001/jama.2015.18603 CrossRefPubMed

30.

De Korte-Verhoef MC, Pasman HR, Schweitzer BP, Francke AL, Onwuteaka-Philipsen BD, Deliens L (2014a) Reasons for hospitalization at the end of life; differences between cancer and non-cancer patients. Support Care Cancer 22:645–652. https://doi.org/10.1007/s00520-013-2019-9 CrossRefPubMed

31.

Barbera L, Paszat L, Qiu F (2008) End-of-life care in lung cancer patients in Ontario: aggressiveness of care in the population and a description of hospital admissions. J Pain Symptom Manag 35:267–274. https://doi.org/10.1016/j.jpainsymman.2007.04.019 CrossRef

32.

Kotajima F, Kobayashi K, Sakaguchi H, Nemoto M (2014) Lung cancer patients frequently visit the emergency room for cancer-related and -unrelated issues. Mol Clin Oncol 2:322–326. https://doi.org/10.3892/mco.2014.241 CrossRefPubMedPubMedCentral

33.

De Korte-Verhoef MC, Pasman HR, Schweitzer BP, Francke AL, Onwuteaka-Philipsen B, Deliens L (2014b) General practitioners’ perspectives on the avoidability of hospitalisations at the end of life: a mixed-method study. Palliat Med 28:949–958. https://doi.org/10.1177/0269216314528742 CrossRefPubMed

34.

Van den Block L, Pivodic L, Pardon K, Donker G, Miccinesi G, Moreels S, Vega Alonso T, Deliens L, Onwuteaka-Philipsen B (2015) Transitions between health care settings in the final three months of life in four EU countries. Eur J Pub Health 25:569–575. https://doi.org/10.1093/eurpub/ckv039 CrossRef

35.

Cohen J, Houttekier D, Onwuteaka-Philipsen B, Miccinesi G, Addington-Hall J, Kaasa S, Bilsen J, Deliens L (2010) Which patients with cancer die at home? A study of six European countries using death certificate data. J Clin Oncol 28:2267–2272. https://doi.org/10.1200/JCO.2009.23.2850 CrossRefPubMed

36.

Cohen J, Pivodic L, Miccinesi G, Onwuteaka-Philipsen BD, Naylor WA, Wilson DM, Loucka M, Csikos A, Pardon K, Van den Block L, Ruiz-Ramos M, Cardenas-Turanzas M, Rhee Y, Aubry R, Hunt K, Teno J, Houttekier D, Deliens L (2015) International study of the place of death of people with cancer: a population-level comparison of 14 countries across 4 continents using death certificate data. Br J Cancer 113:1397–1404. https://doi.org/10.1038/bjc.2015.312 CrossRefPubMedPubMedCentral

37.

Ploemacher J, Israëls AZ, Van der Laan DJ, De Bruin A (2013) Gestandaardiseerde ziekenhuissterfte daalt in de tijd [Standardised in-hospital mortality decreasing over time]. Ned Tijdschr Geneeskd 157:A5267PubMed

38.

Lawson B, Burge FI, Critchley P, McIntyre P (2006) Factors associated with multiple transitions in care during the end of life following enrollment in a comprehensive palliative care program. BMC Palliat Care 5:4. https://doi.org/10.1186/1472-684X-5-4 CrossRefPubMedPubMedCentral

39.

Oosterink JJ, Oosterveld-Vlug MG, Glaudemans JJ, Willems DL, Onwuteaka-Philipsen BD (2016) Interprofessional communication between oncologic specialists and general practitioners on end-of-life issues needs improvement. Fam Pract 33:727–732. https://doi.org/10.1093/fampra/cmw064 CrossRefPubMed

Title: How do treatment aims in the last phase of life relate to hospitalizations and hospital mortality? A mortality follow-back study of Dutch patients with five types of cancer
Authors: Mariska Oosterveld-Vlug
Gé Donker
Femke Atsma
Linda Brom
Yvonne de Man
Stef Groenewoud
Bregje Onwuteaka-Philipsen
Publication date: 01-03-2018
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 3/2018
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-017-3889-z

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2018

A systematic literature review of the prevalence of and risk factors for supportive care needs among women with gynaecological cancer and their caregivers

Can models of self-management support be adapted across cancer types? A comparison of unmet self-management needs for patients with breast or colorectal cancer

Prevalence of delirium in advanced cancer patients in home care and hospice and outcomes after 1 week of palliative care

Oncologists’ responses to patient and caregiver negative emotions and patient perception of quality of communication: results from a multi-ethnic Asian setting

Randomized control trial of benzydamine HCl versus sodium bicarbonate for prophylaxis of concurrent chemoradiation-induced oral mucositis

Defibrotide for the treatment of sinusoidal obstruction syndrome: evaluation of response to therapy and patient outcomes

Keynote webinar | Spotlight on antibody–drug conjugates in cancer