End-of-life care in a population-based cohort of cancer patients: clinical trial participation versus standard of care
- Carrie A Thompson1,
- Sarah E Hugo2,
- Keith Mark Swetz3,
- Paul J Novotny4,
- Jeff A Sloan4,
- Charles L Loprinzi5,
- Timothy J Moynihan5 and
- Tait D Shanafelt1
- 1Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- 2Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- 3Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- 4Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- 5Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
- Correspondence to Dr Carrie A Thompson, Division of Hematology, Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA;
Objectives To evaluate end-of-life care in a cohort of oncology patients in Olmsted County, Minnesota, USA, and compare differences between patients participating in clinical trials and those not in clinical trials.
Methods A population-based cohort of subjects with active oncological disease who died between 2000 and 2002 was constructed retrospectively using institutional databases. Clinical trial participation and care during the last 2 months of life were analysed.
Results A total of 395 eligible patients were identified. In the 2 months prior to death, 94 (24%) patients received chemotherapy, 232 (59%) were hospitalised, 249 (63%) were in hospice and 315 (80%) had a do not resuscitate (DNR) code status. Only 8 (2%) patients received cardiopulmonary resuscitation (CPR) and 26 (7%) patients participated in a clinical trial. Patients in clinical trials were more likely to receive chemotherapy (69.2% vs 20.6%; p<0.001), undergo intubation/mechanical ventilation (15.4% vs 5.4%; p=0.040) and less likely to have DNR code status (50.0% vs 81.8%; p<0.001) when compared with patients not in clinical trials. However, no differences in hospice enrolment, days in hospice, days in the hospital, CPR or location of death were noted.
Conclusions Although opportunities for improvement exist, high quality end-of-life care was found in this study of patients with active malignancy. A majority (over 60%) of patients enrolled in hospice prior to death, 80% had a DNR status and only 2% received CPR. Although clinical trial participants received more aggressive treatments during the last 2 months of life, they did not appear to have lower quality end-of-life care.
- Received 31 May 2012.
- Revision received 15 November 2012.
- Accepted 21 January 2013.
- Published Online First 8 March 2013
- Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions