Factors associated with the aggressiveness of care at the end of life for patients with cancer dying in hospital: a nationwide retrospective cohort study in mainland Portugal

ESMO Open

article

Diogo Martins-Branco¹  Silvia Lopes³  Rita Canario¹  Joao Freire²  Madalena Feio⁶  Jose Ferraz-Goncalves⁷  Gabriela Sousa⁵  Nuno Lunet⁸  Barbara Gomes¹ 

[1] Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London;Medical Oncology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil;NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa;Comprehensive Health Research Centre, Universidade NOVA de Lisboa;Medical Oncology Department, Instituto Português de Oncologia de Coimbra Francisco Gentil;Hospital Palliative Care Support Team, Instituto Português de Oncologia de Lisboa Francisco Gentil;Palliative Care Service, Instituto Português de Oncologia do Porto Francisco Gentil;Department of Public Health and Forensic Sciences and Medical Education, University of Porto Medical School;EPIUnit, Institute of Public Health, University of Porto;Faculty of Medicine, University of Coimbra

关键词: neoplasms;    palliative care;    terminal care;    hospital mortality;    risk factors;   

DOI  :  10.1136/esmoopen-2020-000953

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Introduction There is growing concern about the aggressiveness of cancer care at the end of life (ACCEoL), defined as overly aggressive treatments that compromise the quality of life at its end. Recognising the most affected patients is a cornerstone to improve oncology care. Our aim is to identify factors associated with ACCEoL for patients with cancer dying in hospitals.Methods All adult patients with cancer who died in public hospitals in mainland Portugal (January 2010 to December 2015), identified from the hospital morbidity database. This database provided individual clinical and demographic data. We obtained hospital and region-level variables from a survey and National Statistics. The primary outcome is a composite ACCEoL measure of 16 indicators. We used multilevel random effects logistic regression modelling (p<0·05).Results 14 days in the hospital (43%, 42–43) and surgery (28%, 28–28) in the last 30 days. Older age (p<0·001), breast cancer (OR 0·83; 95% CI 0·76 to 0·91), and metastatic disease (0·54; 95% CI 0·50 to 0·58) were negatively associated with ACCEoL. In contrast, higher Deyo-Charlson Comorbidity Index (p<0·001), gastrointestinal and haematological malignancies (p<0·001), and death at cancer centre (1·31; 95% CI 1·01 to 1·72) or hospital with medical oncology department (1·29; 95% CI 1·02 to 1·63) were positively associated with ACCEoL. There was no association between hospital palliative care services at the hospital of death and ACCEoL.Conclusion Clinical factors related to a better understanding of disease course are associated with ACCEoL reduction. Patients with more comorbidities and gastrointestinal malignancies might represent groups with complex needs, and haematological patients may be at increased risk because of unpredictable prognosis. Improvement of hospital palliative care services could help reduce ACCEoL, particularly in cancer centres and hospitals with medical oncology department, as those services are usually under-resourced, thus reaching few.

【 授权许可】

CC BY|CC BY-NC-ND