End-of-Life Care in the Last Three Months before Death in Older Patients with Cancer in Belgium: A Large Retrospective Cohort Study Using Data Linkage

被引：2

作者：

Depoorter, Victoria ^{[1
]}

Vanschoenbeek, Katrijn ^{[2
]}

Decoster, Lore ^{[3
]}

Silversmit, Geert ^{[2
]}

Debruyne, Philip R. ^{[4
,5
,6
]}

De Groof, Inge ^{[7
]}

Bron, Dominique ^{[8
]}

Cornelis, Frank ^{[9
]}

Luce, Sylvie ^{[10
]}

Focan, Christian ^{[11
]}

Verschaeve, Vincent ^{[12
]}

Debugne, Gwenaelle ^{[13
]}

Langenaeken, Christine ^{[14
]}

Van Den Bulck, Heidi ^{[15
]}

Goeminne, Jean-Charles ^{[16
]}

Teurfs, Wesley ^{[17
]}

Jerusalem, Guy ^{[18
]}

Schrijvers, Dirk ^{[19
]}

Petit, Benedicte ^{[20
]}

Rasschaert, Marika ^{[21
]}

Praet, Jean-Philippe ^{[22
]}

Vandenborre, Katherine ^{[23
]}

De Schutter, Harlinde ^{[2
]}

Milisen, Koen ^{[24
,25
]}

Flamaing, Johan ^{[25
,26
]}

Kenis, Cindy ^{[24
,25
,27
]}

Verdoodt, Freija ^{[2
]}

Wildiers, Hans ^{[1
,27
]}

机构：

[1] Katholieke Univ Leuven, Dept Oncol, B-3000 Leuven, Belgium

[2] Belgian Canc Registry, Res Dept, B-1210 Brussels, Belgium

[3] Vrije Univ Brussel, Univ Ziekenhuis Brussel, Dept Med Oncol, Oncol Ctr, B-1090 Brussels, Belgium

[4] AZ Groeninge, Kortrijk Canc Ctr, Div Med Oncol, B-8500 Kortrijk, Belgium

[5] Anglia Ruskin Univ, Med Technol Res Ctr MTRC, Sch Life Sci, Cambridge CB1 1PT, England

[6] Univ Plymouth, Sch Nursing & Midwifery, Plymouth PL4 8AA, England

[7] Iridium Canc Network Antwerp, Dept Geriatr Med, Sint Augustinus, B-2610 Antwerp, Belgium

[8] ULB, Inst Jules Bordet, Dept Hematol, B-1070 Brussels, Belgium

[9] Clin Univ St Luc UCLouvain, Dept Med Oncol, B-1200 Brussels, Belgium

[10] Univ Libre Bruxelles ULB, Univ Hosp Erasme, Dept Med Oncol, B-1000 Brussels, Belgium

[11] Clin CHC MontLegia, Dept Oncol, Grp Sante CHC Liege, B-4000 Liege, Belgium

[12] GHDC Grand Hop Charleroi, Dept Med Oncol, B-6000 Charleroi, Belgium

[13] Ctr Hosp Mouscron, Dept Geriatr Med, B-7700 Mouscron, Belgium

[14] AZ Klina, Dept Med Oncol, B-2930 Brasschaat, Belgium

[15] Imelda Hosp, Dept Med Oncol, B-2820 Bonheiden, Belgium

[16] CHU UCL Namur, Dept Med Oncol, B-5530 Namur, Belgium

[17] ZNA Stuivenberg, Dept Med Oncol, B-2060 Antwerp, Belgium

[18] Univ Liege, Ctr Hosp Univ Sart Tilman, Dept Med Oncol, B-4000 Liege, Belgium

[19] ZNA Middelheim, Dept Med Oncol, B-2020 Antwerp, Belgium

[20] Ctr Hosp Jolimont, Dept Med Oncol, B-7100 La Louviere, Belgium

[21] Univ Hosp Antwerp, Dept Med Oncol, B-2650 Edegem, Belgium

[22] Free Univ Brussels, Dept Geriatr Med, CHU St Pierre, B-1000 Brussels, Belgium

[23] AZ Vesalius, Dept Med Oncol, B-3700 Tongeren, Belgium

[24] Katholieke Univ Leuven, Acad Ctr Nursing & Midwifery, Dept Publ Hlth & Primary Care, B-3000 Leuven, Belgium

[25] Univ Hosp Leuven, Dept Geriatr Med, B-3000 Leuven, Belgium

[26] Katholieke Univ Leuven, Dept Publ Hlth & Primary Care, Gerontol & Geriatr, B-3000 Leuven, Belgium

[27] Univ Hosp Leuven, Dept Gen Med Oncol, B-3000 Leuven, Belgium

来源：

CANCERS | 2023年 / 15卷 / 13期

关键词：

geriatric oncology; population-based data; specialized palliative care; terminal healthcare utilization; PALLIATIVE CARE; GERIATRIC ASSESSMENT; MEDICARE BENEFICIARIES; SERVICE USE; HEALTH; PEOPLE; ADULTS; AGE; ASSOCIATION; MULTICENTER;

D O I：

10.3390/cancers15133349

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Simple Summary The care older patients with cancer receive in Belgium in the last months of life is not well defined. This study aimed to describe healthcare use at the end of life and explore which factors are associated with palliative care. This study shows that older patients with cancer in Belgium have frequent hospital admissions and emergency department visits before death and that more than half of the patients die in the hospital. Furthermore, we demonstrated that patients with limitations in function and cognition at cancer diagnosis receive less palliative care. This study gives insights into the type of care older patients depend on before death and which older patients receive less palliative care. Ultimately, healthcare use in the end-of-life period should be optimized, and palliative care should be made equally available in older patients with cancer. This study aims to describe end-of-life (EOL) care in older patients with cancer and investigate the association between geriatric assessment (GA) results and specialized palliative care (SPC) use. Older patients with a new cancer diagnosis (2009-2015) originally included in a previous multicentric study were selected if they died before the end of follow-up (2019). At the time of cancer diagnosis, patients underwent geriatric screening with Geriatric 8 (G8) followed by GA in case of a G8 score & LE;14/17. These data were linked to the cancer registry and healthcare reimbursement data for follow-up. EOL care was assessed in the last three months before death, and associations were analyzed using logistic regression. A total of 3546 deceased older patients with cancer with a median age of 79 years at diagnosis were included. Breast, colon, and lung cancer were the most common diagnoses. In the last three months of life, 76.3% were hospitalized, 49.1% had an emergency department visit, and 43.5% received SPC. In total, 55.0% died in the hospital (38.5% in a non-palliative care unit and 16.4% in a palliative care unit). In multivariable analyses, functional and cognitive impairment at cancer diagnosis was associated with less SPC. Further research on optimizing EOL healthcare utilization and broadening access to SPC is needed.

引用

页数：21

共 68 条

[1] Systematic review of the problems and issues of accessing specialist palliative care by patients, carers and health and social care professionals [J].

Ahmed, N ;

Bestall, JC ;

Ahmedzai, SH ;

Payne, SA ;

Clark, D ;

Noble, B .

PALLIATIVE MEDICINE, 2004, 18 (06) :525-542

[2]

[Anonymous], NOM NOM PSEUD HEALTH

[3]

[Anonymous], 1992, INT STAT CLASS DIS R, VVolume 1-3

[4]

ATC, AN THER CHEM ATC CLA

[5] Implementation of geriatric assessment-based recommendations in older patients with cancer: A multicentre prospective study [J].

Baitar, Abdelbari ;

Kenis, Cindy ;

Moor, Ramona ;

Decoster, Lore ;

Luce, Sylvie ;

Bron, Dominique ;

Van Rijswijk, Ruud ;

Rasschaert, Marika ;

Langenaeken, Christine ;

Jerusalem, Guy ;

Lobelle, Jean-Pierre ;

Flamaing, Johan ;

Milisen, Koen ;

Wildiers, Hans .

JOURNAL OF GERIATRIC ONCOLOGY, 2015, 6 (05) :401-410

[6] Comparison of Site of Death, Health Care Utilization, and Hospital Expenditures for Patients Dying With Cancer in 7 Developed Countries [J].

Bekelman, Justin E. ;

Halpern, Scott D. ;

Blankart, Carl Rudolf ;

Bynum, Julie P. ;

Cohen, Joachim ;

Fowler, Robert ;

Kaasa, Stein ;

Kwietniewski, Lukas ;

Melberg, Hans Olav ;

Onwuteaka-Philipsen, Bregje ;

Oosterveld-Vlug, Mariska ;

Pring, Andrew ;

Schreyoegg, Jonas ;

Ulrich, Connie M. ;

Verne, Julia ;

Wunsch, Hannah ;

Emanuel, Ezekiel J. .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2016, 315 (03) :272-283

[7] Patterns of Care and Costs for Older Patients With Colorectal Cancer at the End of Life: Descriptive Study of the United States and Canada [J].

Bremner, Karen E. ;

Yabroff, K. Robin ;

Coughlan, Diarmuid ;

Liu, Ning ;

Zeruto, Christopher ;

Warren, Joan L. ;

de Oliveira, Claire ;

Mariotto, Angela B. ;

Lam, Clara ;

Barrett, Michael J. ;

Chan, Kelvin K. -W. ;

Hoch, Jeffrey S. ;

Krahn, Murray D. .

JCO ONCOLOGY PRACTICE, 2020, 16 (01) :31-+

[8] A NEW METHOD OF CLASSIFYING PROGNOSTIC CO-MORBIDITY IN LONGITUDINAL-STUDIES - DEVELOPMENT AND VALIDATION [J].

CHARLSON, ME ;

POMPEI, P ;

ALES, KL ;

MACKENZIE, CR .

JOURNAL OF CHRONIC DISEASES, 1987, 40 (05) :373-383

[9] The visual analogue pain intensity scale: what is moderate pain in millimetres? [J].

Collins, SL ;

Moore, RA ;

McQuay, HJ .

PAIN, 1997, 72 (1-2) :95-97

[10]

Connor S R., 2020, Global Atlas of Palliative Care, V2nd

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