Aggressive end-of-life care in patients with gastrointestinal cancers - a nationwide study from Denmark

Background: Knowledge of determinants of aggressive end-of-life care is crucial to organizing effective palliative care for patients with gastrointestinal (GI) cancer. Purpose: This study aims to investigate the determinants of aggressive end-of-life care in patients with GI cancer. Methods: A national register-based cohort study using data from the Danish Register on Causes of Death, the Danish National Patient Register, and the Danish Palliative Database was the method of study employed. Participants/Setting: All Danish patients who died from GI cancers from 2010 to 2020 comprised the study setting. Results: There were 43,969 patients with GI cancers in the cohort, of whom 62% were hospitalized in the last 30 days of life, 41% of patients died in the hospital, 10% had surgery, 39% were subjected to a radiological examination during the last 30 days of life and 3% had antineoplastic treatment during the last 14 days of life. Among all types of GI cancers, pancreatic cancer was significantly associated with all outcomes of aggressive end-of-life care except surgery. Patients in specialized palliative care (SPC) had lower odds of receiving aggressive end-of-life care and dying in the hospital. We found that patients with comorbidity and those who were divorced had higher odds of being hospitalized at the end of life and dying in the hospital. Interpretation: Aggressive end-of-life care is associated with disease factors and socio-demographics. The potential to reduce aggressive end-of-life care is considerable in patients with GI cancer, as demonstrated by the impact of SPC. However, we need to address the needs of patients with GI cancer who do not receive SPC.