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Supportive Care in Cancer
Published in: Supportive Care in Cancer 3/2016

Open Access 01-03-2016 | Original Article

Factors associated with aggressive end of life cancer care

Authors: Lesley A. Henson, Barbara Gomes, Jonathan Koffman, Barbara A. Daveson, Irene J. Higginson, Wei Gao, on behalf of BuildCARE

Published in: Supportive Care in Cancer | Issue 3/2016

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Abstract

Background

Many patients with cancer experience aggressive care towards the end of life (EOL) despite evidence of an association with poor outcomes such as prolonged pain and overall dissatisfaction with care.

Purpose

To investigate socio-demographic, clinical and community health care service factors associated with aggressive EOL cancer care.

Methods

An analysis of pooled data from two mortality follow-back surveys was performed. Aggressive EOL care was defined as greater than or equal to one of the following indicators occurring during the last 3 months of life: greater than or equal to two emergency department visits, ≥30 days in hospital and death in hospital.

Results

Of the 681 included patients, 50.1 % were men and mean age at death was 75 years. The majority of patients (59.3 %, 95 % confidence interval (CI) 55.6–63.0 %) experienced at least one indicator of aggressive EOL care: 29.7 % experienced greater than or equal to two ED visits, 17.1 % spent ≥30 days in hospital and 37.9 % died in hospital. Patients with prostate or haematological cancer were more likely to experience aggressive EOL care (adjusted odds ratio (AOR) 4.36, 95 % CI 1.39–13.70, and 4.16, 95 % CI 1.38–12.47, respectively, reference group lung cancer). Patients who received greater than five general practitioner (GP) home visits (AOR 0.37, 95 % CI 0.17–0.82, reference group no GP visits) or had contact with district nursing (AOR 0.48, 95 % CI 0.28–0.83, reference group no contact) or contact with community palliative care services (AOR 0.27, 95 % CI 0.15–0.49, reference group no contact) were less likely to experience aggressive EOL care. No association was found between aggressive EOL care and patients’ age, gender, marital, financial or health status.

Conclusions

Community health care services, in particular contact with community palliative care, are associated with a significant reduction in the odds of cancer patients receiving aggressive EOL care. Expansion of such services may help address the current capacity crises faced by many acute health care systems.
Appendix
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Metadata
Title
Factors associated with aggressive end of life cancer care
Authors
Lesley A. Henson
Barbara Gomes
Jonathan Koffman
Barbara A. Daveson
Irene J. Higginson
Wei Gao
on behalf of BuildCARE
Publication date
01-03-2016
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 3/2016
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-015-2885-4

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