Anticancer Therapy at the End of Life: Lessons From a Community Cancer Institute

Shanthi Sivendran, Selah Lynch, Caitlyn McNaughton, Riley Wong, Sarah Svetec, Jason H. Moore, Rachel Holliday, Randall A. Oyer, Kristina Newport

Research output: Contribution to journalArticle

Abstract

Introduction: Studies have shown aggressive cancer care at the end of life is associated with decreased quality of life, decreased median survival, and increased cost of care. This study describes the patients most likely to receive systemic anticancer therapy at the end of life in a community cancer institute. Materials and Methods: We performed a retrospective cohort study of 201 patients who received systemic anticancer therapy in our institution and died between July 2016 and April 2017. Data collected included primary malignancy, hospice enrollment, healthcare utilization, Oncology Care Model (OCM) enrollment, and clinical assessments at last office visit prior to a treatment decision before death. We defined our outcome variable as the receipt of anticancer treatment in the last 14 days of a patient’s life. We evaluated 20 clinical exposure variables with respect to the outcome classes. Risk ratios along with their associated confidence intervals and P values were calculated. Significance was determined using the Benjamini-Hochberg procedure to account for multiple testing. Results: Of the 201 patients who died of cancer, 36 (17%) received anticancer therapy within the last 14 days of life. Several risk factors were significantly positively associated with receiving anticancer therapy at the end of life including hospitalization within 30 days of end of life, number of hospitalizations per patient (≥2), death in hospital, enrollment in OCM, and a diagnosis of hematologic malignancy. Conclusion: Our findings demonstrate those enrolled in the OCM and those with hematologic malignancies have a higher risk of receiving anticancer therapy in the last 14 days of life. These observations highlight the need for better identifying the needs of high-risk patients and providing good quality care throughout the disease trajectory to better align end-of-life care with patients’ wishes.

Original languageEnglish (US)
JournalJournal of Palliative Care
DOIs
StatePublished - Jan 1 2019

Fingerprint

Neoplasms
Terminal Care
Hematologic Neoplasms
Therapeutics
Hospitalization
Office Visits
Hospices
Quality of Health Care
Cohort Studies
Retrospective Studies
Odds Ratio
Quality of Life
Confidence Intervals
Delivery of Health Care
Costs and Cost Analysis
Survival

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Sivendran, Shanthi ; Lynch, Selah ; McNaughton, Caitlyn ; Wong, Riley ; Svetec, Sarah ; Moore, Jason H. ; Holliday, Rachel ; Oyer, Randall A. ; Newport, Kristina. / Anticancer Therapy at the End of Life : Lessons From a Community Cancer Institute. In: Journal of Palliative Care. 2019.
@article{fa58eb649e1c44179e4c638a5d0a9503,
title = "Anticancer Therapy at the End of Life: Lessons From a Community Cancer Institute",
abstract = "Introduction: Studies have shown aggressive cancer care at the end of life is associated with decreased quality of life, decreased median survival, and increased cost of care. This study describes the patients most likely to receive systemic anticancer therapy at the end of life in a community cancer institute. Materials and Methods: We performed a retrospective cohort study of 201 patients who received systemic anticancer therapy in our institution and died between July 2016 and April 2017. Data collected included primary malignancy, hospice enrollment, healthcare utilization, Oncology Care Model (OCM) enrollment, and clinical assessments at last office visit prior to a treatment decision before death. We defined our outcome variable as the receipt of anticancer treatment in the last 14 days of a patient’s life. We evaluated 20 clinical exposure variables with respect to the outcome classes. Risk ratios along with their associated confidence intervals and P values were calculated. Significance was determined using the Benjamini-Hochberg procedure to account for multiple testing. Results: Of the 201 patients who died of cancer, 36 (17{\%}) received anticancer therapy within the last 14 days of life. Several risk factors were significantly positively associated with receiving anticancer therapy at the end of life including hospitalization within 30 days of end of life, number of hospitalizations per patient (≥2), death in hospital, enrollment in OCM, and a diagnosis of hematologic malignancy. Conclusion: Our findings demonstrate those enrolled in the OCM and those with hematologic malignancies have a higher risk of receiving anticancer therapy in the last 14 days of life. These observations highlight the need for better identifying the needs of high-risk patients and providing good quality care throughout the disease trajectory to better align end-of-life care with patients’ wishes.",
author = "Shanthi Sivendran and Selah Lynch and Caitlyn McNaughton and Riley Wong and Sarah Svetec and Moore, {Jason H.} and Rachel Holliday and Oyer, {Randall A.} and Kristina Newport",
year = "2019",
month = "1",
day = "1",
doi = "10.1177/0825859719851484",
language = "English (US)",
journal = "Journal of Palliative Care",
issn = "0825-8597",
publisher = "Institut Universitaire de Geriatrie de Montreal",

}

Anticancer Therapy at the End of Life : Lessons From a Community Cancer Institute. / Sivendran, Shanthi; Lynch, Selah; McNaughton, Caitlyn; Wong, Riley; Svetec, Sarah; Moore, Jason H.; Holliday, Rachel; Oyer, Randall A.; Newport, Kristina.

In: Journal of Palliative Care, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Anticancer Therapy at the End of Life

T2 - Lessons From a Community Cancer Institute

AU - Sivendran, Shanthi

AU - Lynch, Selah

AU - McNaughton, Caitlyn

AU - Wong, Riley

AU - Svetec, Sarah

AU - Moore, Jason H.

AU - Holliday, Rachel

AU - Oyer, Randall A.

AU - Newport, Kristina

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Studies have shown aggressive cancer care at the end of life is associated with decreased quality of life, decreased median survival, and increased cost of care. This study describes the patients most likely to receive systemic anticancer therapy at the end of life in a community cancer institute. Materials and Methods: We performed a retrospective cohort study of 201 patients who received systemic anticancer therapy in our institution and died between July 2016 and April 2017. Data collected included primary malignancy, hospice enrollment, healthcare utilization, Oncology Care Model (OCM) enrollment, and clinical assessments at last office visit prior to a treatment decision before death. We defined our outcome variable as the receipt of anticancer treatment in the last 14 days of a patient’s life. We evaluated 20 clinical exposure variables with respect to the outcome classes. Risk ratios along with their associated confidence intervals and P values were calculated. Significance was determined using the Benjamini-Hochberg procedure to account for multiple testing. Results: Of the 201 patients who died of cancer, 36 (17%) received anticancer therapy within the last 14 days of life. Several risk factors were significantly positively associated with receiving anticancer therapy at the end of life including hospitalization within 30 days of end of life, number of hospitalizations per patient (≥2), death in hospital, enrollment in OCM, and a diagnosis of hematologic malignancy. Conclusion: Our findings demonstrate those enrolled in the OCM and those with hematologic malignancies have a higher risk of receiving anticancer therapy in the last 14 days of life. These observations highlight the need for better identifying the needs of high-risk patients and providing good quality care throughout the disease trajectory to better align end-of-life care with patients’ wishes.

AB - Introduction: Studies have shown aggressive cancer care at the end of life is associated with decreased quality of life, decreased median survival, and increased cost of care. This study describes the patients most likely to receive systemic anticancer therapy at the end of life in a community cancer institute. Materials and Methods: We performed a retrospective cohort study of 201 patients who received systemic anticancer therapy in our institution and died between July 2016 and April 2017. Data collected included primary malignancy, hospice enrollment, healthcare utilization, Oncology Care Model (OCM) enrollment, and clinical assessments at last office visit prior to a treatment decision before death. We defined our outcome variable as the receipt of anticancer treatment in the last 14 days of a patient’s life. We evaluated 20 clinical exposure variables with respect to the outcome classes. Risk ratios along with their associated confidence intervals and P values were calculated. Significance was determined using the Benjamini-Hochberg procedure to account for multiple testing. Results: Of the 201 patients who died of cancer, 36 (17%) received anticancer therapy within the last 14 days of life. Several risk factors were significantly positively associated with receiving anticancer therapy at the end of life including hospitalization within 30 days of end of life, number of hospitalizations per patient (≥2), death in hospital, enrollment in OCM, and a diagnosis of hematologic malignancy. Conclusion: Our findings demonstrate those enrolled in the OCM and those with hematologic malignancies have a higher risk of receiving anticancer therapy in the last 14 days of life. These observations highlight the need for better identifying the needs of high-risk patients and providing good quality care throughout the disease trajectory to better align end-of-life care with patients’ wishes.

UR - http://www.scopus.com/inward/record.url?scp=85067882648&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067882648&partnerID=8YFLogxK

U2 - 10.1177/0825859719851484

DO - 10.1177/0825859719851484

M3 - Article

C2 - 31187695

AN - SCOPUS:85067882648

JO - Journal of Palliative Care

JF - Journal of Palliative Care

SN - 0825-8597

ER -