Comparing the use of aggressive end-of life care among frail and non-frail patients with cancer using a claims-based frailty index.

Autor: Sachdev R; Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, 44106, USA., Shearn-Nance G; Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, 44106, USA., Vu L; Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, WG-49, Cleveland, OH 44106-4945, USA., Bensken WP; Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, WG-49, Cleveland, OH 44106-4945, USA., Douglas SL; Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH. 44104, USA., Koroukian SM; Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, WG-49, Cleveland, OH 44106-4945, USA., Rose J; Center for Community Health Integration, Case Western Reserve University School of Medicine, 11000 Cedar Ave., Ste. 402, Cleveland, OH 44106-7136, USA. Electronic address: jxr109@case.edu.
Jazyk: angličtina
Zdroj: Journal of geriatric oncology [J Geriatr Oncol] 2024 Mar; Vol. 15 (2), pp. 101706. Date of Electronic Publication: 2024 Feb 05.
DOI: 10.1016/j.jgo.2024.101706
Abstrakt: Introduction: Despite mounting consensus that end-of-life (EOL) care for patients with cancer should focus on improving quality of life, many patients continue to receive aggressive, disease-oriented treatment until death. Within this group, patients with increased frailty may be at higher risk of adverse treatment-related outcomes. We therefore examined the relationship between degree of frailty and receipt of aggressive EOL care among Medicare-insured patients with cancer in Ohio.
Materials and Methods: From the Ohio Cancer Incidence Surveillance System (OCISS) linked with Medicare claims, we identified patients diagnosed with breast, colorectal, lung, or prostate cancer who died between 2012 and 2016. Frailty was operationalized using a validated claims-based frailty index. Six quality indicators reflecting receipt of aggressive EOL care were identified from claims: (1) any cancer-directed treatment, (2) >1 emergency department (ED) visit, (3) >1 hospital admission, (4) any intensive care unit (ICU) admission in the last 30 days of life, (5) entry to hospice in the last three days of life, and (6) in-hospital mortality. Multivariable logistic regression analysis was performed to control for demographic factors, Medicare and Medicaid dual enrollment, and cancer type and stage in the relationship between frailty and aggressive EOL care.
Results: Overall, 31,465 patients met selection criteria. Patients with moderate/severe frailty were less likely than non-/pre-frail patients to receive any aggressive EOL care (adjusted odds ratio [aOR] 0.92 [95% confidence interval 0.86-0.99]). This group was also less likely to undergo cancer-directed treatment in their last 30 days or to enter hospice in their last three days. Increasing frailty was associated with lower odds of admission to the ICU in the last 30 days of life (mild frailty: aOR 0.88 [0.83-0.94]; moderate/severe frailty: aOR 0.85 [0.78-0.92]) or of dying in-hospital (mild frailty: 0.85 [0.79-0.91]; moderate/severe frailty: aOR 0.74 [0.67-0.82]), but higher odds of having >1 ED visit in the last 30 days of life (mild frailty: aOR 1.43 [1.32-1.53]; moderate/severe frailty: aOR 1.61 [1.47-1.77]).
Discussion: These findings suggest the need for more explicit discussion of emergency care seeking for patients with cancer at the end of life.
Competing Interests: Declaration of Competing Interest The authors of this manuscript certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
(Copyright © 2023. Published by Elsevier Ltd.)
Databáze: MEDLINE
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