Kersti Oselin1, Heti Pisarev2, Keit Ilau3, Raul-Allan Kiivet2. 1. Department of Chemotherapy, Clinic of Haematology and Oncology, North Estonia Medical Centre, J. Sütiste tee 19, 13419, Tallinn, Estonia. kersti.oselin@regionaalhaigla.ee. 2. Institute of Family Medicine and Public Health, Tartu University, Tartu, Estonia. 3. Pharmacy, North Estonia Medical Centre, Tallinn, Estonia.
Abstract
BACKGROUND: We aimed to study the mortality and intensity of health care in patients with advanced lung cancer who received systemic anti-cancer treatment (SACT) compared with patients who were not eligible for SACT (no-SACT). METHODS: A retrospective cohort of patients with lung cancer, who were treated at the North Estonia Medical Centre from 2015 to 2017, was linked to population-based health care data from the Estonian Health Insurance Fund. We calculated 14- and 30-day mortality after SACT and used a composite measure of intensity of care, comprised from the following: emergency department visit, admission to hospital, admission to intensive care unit, receipt of radiotherapy or systemic treatment. RESULTS: The median overall survival (OS) of patients who received at least one cycle of SACT (n = 489) was 9.1 months and in patients with no-SACT (n = 289) 1.3 months (hazard ratio [HR] = 4.23, 95% CI = 3.60-5.00). During the final 30 days of life, intensive EOL care was received by 69.9% of the SACT patients and 43.7% of the no-SACT patients. Intensive EOL care in the last 30 days of life is more probable among patients in the SACT group (odds ratio [OR] = 3.58, 95% CI = 2.54-5.04, p < 0.001), especially in those with a stage IV disease (OR = 1.89, 95% CI = 1.31-2.71, p = 0.001). In the SACT group 6.7 and 14.7% of patients died within 14 days and 30 days after the last cycle, respectively. CONCLUSIONS: Significant proportion of patients with advanced lung cancer continue to receive intensive care near death. Our results reflect current patterns of EOL care for patients with lung cancer in Estonia. Availability of palliative care and hospice services must be increased to improve resource use and patient-oriented care.
BACKGROUND: We aimed to study the mortality and intensity of health care in patients with advanced lung cancer who received systemic anti-cancer treatment (SACT) compared with patients who were not eligible for SACT (no-SACT). METHODS: A retrospective cohort of patients with lung cancer, who were treated at the North Estonia Medical Centre from 2015 to 2017, was linked to population-based health care data from the Estonian Health Insurance Fund. We calculated 14- and 30-day mortality after SACT and used a composite measure of intensity of care, comprised from the following: emergency department visit, admission to hospital, admission to intensive care unit, receipt of radiotherapy or systemic treatment. RESULTS: The median overall survival (OS) of patients who received at least one cycle of SACT (n = 489) was 9.1 months and in patients with no-SACT (n = 289) 1.3 months (hazard ratio [HR] = 4.23, 95% CI = 3.60-5.00). During the final 30 days of life, intensive EOL care was received by 69.9% of the SACTpatients and 43.7% of the no-SACTpatients. Intensive EOL care in the last 30 days of life is more probable among patients in the SACT group (odds ratio [OR] = 3.58, 95% CI = 2.54-5.04, p < 0.001), especially in those with a stage IV disease (OR = 1.89, 95% CI = 1.31-2.71, p = 0.001). In the SACT group 6.7 and 14.7% of patientsdied within 14 days and 30 days after the last cycle, respectively. CONCLUSIONS: Significant proportion of patients with advanced lung cancer continue to receive intensive care near death. Our results reflect current patterns of EOL care for patients with lung cancer in Estonia. Availability of palliative care and hospice services must be increased to improve resource use and patient-oriented care.
Entities:
Keywords:
Advanced lung cancer; End-of-life care; High intensity care
Authors: Lowell E Schnipper; Thomas J Smith; Derek Raghavan; Douglas W Blayney; Patricia A Ganz; Therese Marie Mulvey; Dana S Wollins Journal: J Clin Oncol Date: 2012-04-03 Impact factor: 44.544
Authors: Rong Wang; Amer M Zeidan; Stephanie Halene; Xiao Xu; Amy J Davidoff; Scott F Huntington; Nikolai A Podoltsev; Cary P Gross; Steven D Gore; Xiaomei Ma Journal: J Clin Oncol Date: 2017-08-07 Impact factor: 44.544
Authors: Jennifer S Temel; Joseph A Greer; Alona Muzikansky; Emily R Gallagher; Sonal Admane; Vicki A Jackson; Constance M Dahlin; Craig D Blinderman; Juliet Jacobsen; William F Pirl; J Andrew Billings; Thomas J Lynch Journal: N Engl J Med Date: 2010-08-19 Impact factor: 91.245
Authors: Lisa Barbera; Hsien Seow; Rinku Sutradhar; Anna Chu; Fred Burge; Konrad Fassbender; Kim McGrail; Beverley Lawson; Ying Liu; Reka Pataky; Alex Potapov Journal: J Oncol Pract Date: 2015-04-28 Impact factor: 3.840
Authors: Holly G Prigerson; Yuhua Bao; Manish A Shah; M Elizabeth Paulk; Thomas W LeBlanc; Bryan J Schneider; Melissa M Garrido; M Carrington Reid; David A Berlin; Kerin B Adelson; Alfred I Neugut; Paul K Maciejewski Journal: JAMA Oncol Date: 2015-09 Impact factor: 31.777
Authors: Michael Wallington; Emma B Saxon; Martine Bomb; Rebecca Smittenaar; Matthew Wickenden; Sean McPhail; Jem Rashbass; David Chao; John Dewar; Denis Talbot; Michael Peake; Timothy Perren; Charles Wilson; David Dodwell Journal: Lancet Oncol Date: 2016-08-30 Impact factor: 41.316