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BMC Palliative Care
Published in: BMC Palliative Care 1/2022

Open Access 01-12-2022 | Care | Research

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

Authors: Chetna Malhotra, Filipinas Bundoc, Isha Chaudhry, Irene Teo, Semra Ozdemir, Eric Finkelstein, on behalf of COMPASS study group

Published in: BMC Palliative Care | Issue 1/2022

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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

Appendix
Available only for authorised users
Footnotes
1
National Cancer Centre, Singapore, Singapore
 
2
National University Cancer Institute, National University Hospital, Singapore, Singapore
 
3
Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
 
4
Program in Health Services Systems Research, Duke-NUS Medical School, Singapore, Singapore
 
5
Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
 
6
Tan Tock Seng Hospital, Singapore, Singapore
 
7
Dover Park Hospice, Singapore, Singapore
 
8
King’s College London, Cicely Saunders Institute, London, UK
 
9
Singapore General Hospital
 
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Metadata
Title
A prospective cohort study assessing aggressive interventions at the end-of-life among patients with solid metastatic cancer
Authors
Chetna Malhotra
Filipinas Bundoc
Isha Chaudhry
Irene Teo
Semra Ozdemir
Eric Finkelstein
on behalf of COMPASS study group
Publication date
01-12-2022
Publisher
BioMed Central
Keyword
Care
Published in
BMC Palliative Care / Issue 1/2022
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/s12904-022-00970-z

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