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Original research
End-of-life interventions in patients with cancer
  1. Colleen Webber1,2,
  2. Shuaib Hafid3,
  3. Anastasia Gayowsky4,
  4. Michelle Howard3,
  5. Peter Tanuseputro1,2,5,
  6. Aaron Jones4,6,
  7. Mary M Scott1,2,
  8. Amy T Hsu1,2,7,
  9. James Downar1,2,5,
  10. Doug Manuel1,2,7,
  11. Katrin Conen8 and
  12. Sarina Roslyn Isenberg2,5,9
  1. 1 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  2. 2 Bruyère Research Institute, Ottawa, Ontario, Canada
  3. 3 Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
  4. 4 ICES, Hamilton, Ontario, Canada
  5. 5 Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  6. 6 Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
  7. 7 Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
  8. 8 Department of Medicine, Walker Family Cancer Centre and Niagara Health Sciences, McMaster University, Hamilton, Ontario, Canada
  9. 9 Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Colleen Webber, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada; cowebber{at}ohri.ca

Abstract

Objectives To describe variations in the receipt of potentially inappropriate interventions in the last 100 days of life of patients with cancer according to patient characteristics and cancer site.

Methods We conducted a population-based retrospective cohort study of cancer decedents in Ontario, Canada who died between 1 January 2013 and 31 December 2018. Potentially inappropriate interventions, including chemotherapy, major surgery, intensive care unit admission, cardiopulmonary resuscitation, defibrillation, dialysis, percutaneous coronary intervention, mechanical ventilation, feeding tube placement, blood transfusion and bronchoscopy, were captured via hospital discharge records. We used Poisson regression to examine associations between interventions and decedent age, sex, rurality, income and cancer site.

Results Among 151 618 decedents, 81.3% received at least one intervention, and 21.4% received 3+ different interventions. Older patients (age 95–105 years vs 19–44 years, rate ratio (RR) 0.36, 95% CI 0.34 to 0.38) and women (RR 0.94, 95% CI 0.93 to 0.94) had lower intervention rates. Rural patients (RR 1.09, 95% CI 1.08 to 1.10), individuals in the highest area-level income quintile (vs lowest income quintile RR 1.02, 95% CI 1.01 to 1.04), and patients with pancreatic cancer (vs colorectal cancer RR 1.10, 95% CI 1.07 to 1.12) had higher intervention rates.

Conclusions Potentially inappropriate interventions were common in the last 100 days of life of cancer decedents. Variations in interventions may reflect differences in prognostic awareness, healthcare access, and care preferences and quality. Earlier identification of patients’ palliative care needs and involvement of palliative care specialists may help reduce the use of these interventions at the end of life.

  • Terminal care
  • Hospital care
  • Cancer

Data availability statement

Data may be obtained from a third party and are not publicly available. The data set from this study is held securely in coded form at ICES. While data sharing agreements prohibit ICES from making the data set publicly available, access may be granted to those who meet pre­specified criteria for confidential access, available at www.ices.on.ca/DAS. The full data set creation plan and underlying analytical code are available from the authors upon request, understanding that the computer programs may rely upon coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification.

https://doi.org/10.1136/spcare-2023-004222

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. The data set from this study is held securely in coded form at ICES. While data sharing agreements prohibit ICES from making the data set publicly available, access may be granted to those who meet pre­specified criteria for confidential access, available at www.ices.on.ca/DAS. The full data set creation plan and underlying analytical code are available from the authors upon request, understanding that the computer programs may rely upon coding templates or macros that are unique to ICES and are therefore either inaccessible or may require modification.

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    Footnotes

    • X @mhoward101, @queenofscotts10, @amytmhsu, @jamesdownar, @sarina_isenberg

    • Contributors Substantial contributions to the conception or design of the work: All authors. Acquisition and interpretation of data for the work: All authors. Data analysis: AG. Drafting the work: CW. Reviewing the manuscript critically for important intellectual content: All authors. Final approval of the version to be published: All authors. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: All authors. Responsible for the overall content as guarantor: CW

    • Funding This study was funded by a grant from the Canadian Institutes of Health Research project #159771.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.