BACKGROUND: Age differences may help to explain discrepancies in medical care received by cancer patients near death. OBJECTIVES: Understanding age differences in advanced cancer patients' end-of-life experiences. DESIGN: NCI and NIMH funded multi-site prospective cohort study. PARTICIPANTS: 396 deceased cancer patients, mean age (58.6 +/- 12.5), in the Coping with Cancer study. MEASUREMENTS: Baseline interviews (Treatment Preference) and 1 week postmortem chart reviews (Treatment Received). RESULTS: 14.1% of patients were 20-44 years old, 54.0% were 45-64 years old, and 31.8% were > or = 65 years old. Compared to younger patients, middle-aged patients wanted less life-prolonging care (OR 0.32; CI 0.16-0.64). In the last week of life, older patients were less likely to undergo ventilation (OR 0.27; CI 0.07-1.00) than younger patients. Middle-aged patients who preferred life-prolonging care were less likely to receive it than younger patients (OR 0.21; CI 0.08-0.54), but were more likely to avoid unwanted life-prolonging care (OR 2.38; CI 1.20-4.75) than younger patients. Older patients were less likely to receive desired life-prolonging care than younger patients (OR 0.23; CI 0.08-0.68), however, they were not more likely to avoid unwanted life-prolonging care than younger patients (OR 1.74; CI 0.87-3.47). CONCLUSIONS: Likelihood of a patient's treatment preference being consistent with care differ by age and treatment preferences. Older patients preferring life-prolonging therapies are less likely to receive them than younger patients; middle-aged patients who want to avoid life-prolonging care are more likely to do so than younger patients. Both findings have implications for patients' quality-of-death, indicating a need for further research.
BACKGROUND: Age differences may help to explain discrepancies in medical care received by cancerpatients near death. OBJECTIVES: Understanding age differences in advanced cancerpatients' end-of-life experiences. DESIGN: NCI and NIMH funded multi-site prospective cohort study. PARTICIPANTS: 396 deceased cancerpatients, mean age (58.6 +/- 12.5), in the Coping with Cancer study. MEASUREMENTS: Baseline interviews (Treatment Preference) and 1 week postmortem chart reviews (Treatment Received). RESULTS: 14.1% of patients were 20-44 years old, 54.0% were 45-64 years old, and 31.8% were > or = 65 years old. Compared to younger patients, middle-aged patients wanted less life-prolonging care (OR 0.32; CI 0.16-0.64). In the last week of life, older patients were less likely to undergo ventilation (OR 0.27; CI 0.07-1.00) than younger patients. Middle-aged patients who preferred life-prolonging care were less likely to receive it than younger patients (OR 0.21; CI 0.08-0.54), but were more likely to avoid unwanted life-prolonging care (OR 2.38; CI 1.20-4.75) than younger patients. Older patients were less likely to receive desired life-prolonging care than younger patients (OR 0.23; CI 0.08-0.68), however, they were not more likely to avoid unwanted life-prolonging care than younger patients (OR 1.74; CI 0.87-3.47). CONCLUSIONS: Likelihood of a patient's treatment preference being consistent with care differ by age and treatment preferences. Older patients preferring life-prolonging therapies are less likely to receive them than younger patients; middle-aged patients who want to avoid life-prolonging care are more likely to do so than younger patients. Both findings have implications for patients' quality-of-death, indicating a need for further research.
Authors: M B Hamel; J Lynn; J M Teno; K E Covinsky; A W Wu; A Galanos; N A Desbiens; R S Phillips Journal: J Am Geriatr Soc Date: 2000-05 Impact factor: 5.562
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Authors: Seelwan Sathitratanacheewin; Ruth A Engelberg; Lois Downey; Robert Y Lee; James A Fausto; Helene Starks; Ben Dunlap; James Sibley; William Lober; Elizabeth T Loggers; Nita Khandelwal; J Randall Curtis Journal: J Pain Symptom Manage Date: 2017-09-05 Impact factor: 3.612