Palliative care among metastatic breast cancer patients in the end-of-life period in the U.S

Autor: Divya S. Subramaniam, Zidong Zhang, Alexandria Jenkins, Leslie J. Hinyard
Rok vydání: 2022
Předmět:
Zdroj: Journal of Clinical Oncology. 40:e13002-e13002
ISSN: 1527-7755
0732-183X
DOI: 10.1200/jco.2022.40.16_suppl.e13002
Popis: e13002 Background: Research has shown that palliative care improves the quality of end of life care, and lowers associated costs for cancer patients. The purpose of this study was to determine utilization of palliative care consult (PCC) on or after date of metastasis to date of death, the association of emergency department (ED), intensive care unit (ICU) and chemotherapies among metastatic breast cancer (MBC) patients in the United States. Methods: We conducted a retrospective study using the de-identified electronic medical record data from a national healthcare informatics provider and insurer between January 1, 2000 and December 31, 2018. The MBC patients (age ≥ 18 years) who were diagnosed with a secondary neoplasm after the index diagnosis of breast cancer and deceased in the period of data capture were included. The cohort was split into the PCC groups, patients who had received at least one PCC on or after the date of metastasis through date of death; and the non-PCC group. The ED, ICU and chemotherapy encounters since metastasis were defined by ICD-9/10, HCPCS or CPT codes per encounter records. We quantified the ED and ICU visits within two months of death; and the antineoplastic chemotherapies within one and two months of death. Time from metastasis to death and utilization of services were compared between the PCC and the non-PCC groups using Whitney U-test and Chi-squared test. Results: 979 deceased MBC patients had at least one PCC and 1,636 did not at all. Overall, average patient age at the last admission was 68.7+/-12.9 years. The median time from metastasis to death was 9 (2 – 24) years. More than half of them were Caucasian (79.8%) and nearly half from the Midwest region (47.1%). Between the two groups, age distribution was not significantly different, but the PCC patients were more likely to have shorter time to death (8 vs 10 years), be African American (12.8% vs 9.8%), reside in Midwest (52.9% vs 43.7%) and have experienced complications since metastasis except for acute cerebrovascular events. Compared to the non-PCC patients, the PCC patients were more likely to use ED (52.2% vs 22.2%), ICU (12.5% vs 13.4%) within two months of death, and to receive chemotherapy within one and two months of death (17.7% vs 13.9% and 12.9% vs 6.0%, respectively). Conclusions: Our study found that only 38% of BC patients received at least one PCC following date of metastatic diagnosis. Findings highlight the need to increase PCC among MBC patients immediately following diagnosis to ensure appropriate care is provided and utilized. Furthermore, educational and informational interventions will need to be developed to boost PCC utilization among MBC patients.
Databáze: OpenAIRE
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