Intensity of end-of-life health care and mortality after systemic anti-cancer treatment in patients with advanced lung cancer
Abstract Background We aimed to study the mortality and intensity of health care in patients with advanced lung cancer who received systemic anti-cancer treatment (SACT) compared with patients who were not eligible for SACT (no-SACT). Methods A retrospective cohort of patients with lung cancer, who...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-03-01
|
| Series: | BMC Cancer |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12885-021-07992-5 |
| _version_ | 1818863486134910976 |
|---|---|
| author | Kersti Oselin Heti Pisarev Keit Ilau Raul-Allan Kiivet |
| author_facet | Kersti Oselin Heti Pisarev Keit Ilau Raul-Allan Kiivet |
| author_sort | Kersti Oselin |
| collection | DOAJ |
| description | Abstract Background We aimed to study the mortality and intensity of health care in patients with advanced lung cancer who received systemic anti-cancer treatment (SACT) compared with patients who were not eligible for SACT (no-SACT). Methods A retrospective cohort of patients with lung cancer, who were treated at the North Estonia Medical Centre from 2015 to 2017, was linked to population-based health care data from the Estonian Health Insurance Fund. We calculated 14- and 30-day mortality after SACT and used a composite measure of intensity of care, comprised from the following: emergency department visit, admission to hospital, admission to intensive care unit, receipt of radiotherapy or systemic treatment. Results The median overall survival (OS) of patients who received at least one cycle of SACT (n = 489) was 9.1 months and in patients with no-SACT (n = 289) 1.3 months (hazard ratio [HR] = 4.23, 95% CI = 3.60–5.00). During the final 30 days of life, intensive EOL care was received by 69.9% of the SACT patients and 43.7% of the no-SACT patients. Intensive EOL care in the last 30 days of life is more probable among patients in the SACT group (odds ratio [OR] = 3.58, 95% CI = 2.54–5.04, p < 0.001), especially in those with a stage IV disease (OR = 1.89, 95% CI = 1.31–2.71, p = 0.001). In the SACT group 6.7 and 14.7% of patients died within 14 days and 30 days after the last cycle, respectively. Conclusions Significant proportion of patients with advanced lung cancer continue to receive intensive care near death. Our results reflect current patterns of EOL care for patients with lung cancer in Estonia. Availability of palliative care and hospice services must be increased to improve resource use and patient-oriented care. |
| first_indexed | 2024-12-19T10:16:31Z |
| format | Article |
| id | doaj.art-d0819c28bfaa40ad92c87560ed6aefcd |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-12-19T10:16:31Z |
| publishDate | 2021-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj.art-d0819c28bfaa40ad92c87560ed6aefcd2022-12-21T20:26:12ZengBMCBMC Cancer1471-24072021-03-0121111010.1186/s12885-021-07992-5Intensity of end-of-life health care and mortality after systemic anti-cancer treatment in patients with advanced lung cancerKersti Oselin0Heti Pisarev1Keit Ilau2Raul-Allan Kiivet3Department of Chemotherapy, Clinic of Haematology and Oncology, North Estonia Medical CentreInstitute of Family Medicine and Public Health, Tartu UniversityPharmacy, North Estonia Medical CentreInstitute of Family Medicine and Public Health, Tartu UniversityAbstract Background We aimed to study the mortality and intensity of health care in patients with advanced lung cancer who received systemic anti-cancer treatment (SACT) compared with patients who were not eligible for SACT (no-SACT). Methods A retrospective cohort of patients with lung cancer, who were treated at the North Estonia Medical Centre from 2015 to 2017, was linked to population-based health care data from the Estonian Health Insurance Fund. We calculated 14- and 30-day mortality after SACT and used a composite measure of intensity of care, comprised from the following: emergency department visit, admission to hospital, admission to intensive care unit, receipt of radiotherapy or systemic treatment. Results The median overall survival (OS) of patients who received at least one cycle of SACT (n = 489) was 9.1 months and in patients with no-SACT (n = 289) 1.3 months (hazard ratio [HR] = 4.23, 95% CI = 3.60–5.00). During the final 30 days of life, intensive EOL care was received by 69.9% of the SACT patients and 43.7% of the no-SACT patients. Intensive EOL care in the last 30 days of life is more probable among patients in the SACT group (odds ratio [OR] = 3.58, 95% CI = 2.54–5.04, p < 0.001), especially in those with a stage IV disease (OR = 1.89, 95% CI = 1.31–2.71, p = 0.001). In the SACT group 6.7 and 14.7% of patients died within 14 days and 30 days after the last cycle, respectively. Conclusions Significant proportion of patients with advanced lung cancer continue to receive intensive care near death. Our results reflect current patterns of EOL care for patients with lung cancer in Estonia. Availability of palliative care and hospice services must be increased to improve resource use and patient-oriented care.https://doi.org/10.1186/s12885-021-07992-5Advanced lung cancerEnd-of-life careHigh intensity care |
| spellingShingle | Kersti Oselin Heti Pisarev Keit Ilau Raul-Allan Kiivet Intensity of end-of-life health care and mortality after systemic anti-cancer treatment in patients with advanced lung cancer BMC Cancer Advanced lung cancer End-of-life care High intensity care |
| title | Intensity of end-of-life health care and mortality after systemic anti-cancer treatment in patients with advanced lung cancer |
| title_full | Intensity of end-of-life health care and mortality after systemic anti-cancer treatment in patients with advanced lung cancer |
| title_fullStr | Intensity of end-of-life health care and mortality after systemic anti-cancer treatment in patients with advanced lung cancer |
| title_full_unstemmed | Intensity of end-of-life health care and mortality after systemic anti-cancer treatment in patients with advanced lung cancer |
| title_short | Intensity of end-of-life health care and mortality after systemic anti-cancer treatment in patients with advanced lung cancer |
| title_sort | intensity of end of life health care and mortality after systemic anti cancer treatment in patients with advanced lung cancer |
| topic | Advanced lung cancer End-of-life care High intensity care |
| url | https://doi.org/10.1186/s12885-021-07992-5 |
| work_keys_str_mv | AT kerstioselin intensityofendoflifehealthcareandmortalityaftersystemicanticancertreatmentinpatientswithadvancedlungcancer AT hetipisarev intensityofendoflifehealthcareandmortalityaftersystemicanticancertreatmentinpatientswithadvancedlungcancer AT keitilau intensityofendoflifehealthcareandmortalityaftersystemicanticancertreatmentinpatientswithadvancedlungcancer AT raulallankiivet intensityofendoflifehealthcareandmortalityaftersystemicanticancertreatmentinpatientswithadvancedlungcancer |