Isabeau S L van Brakel1, Martijn M Stuiver2, Sjoerd M Euser1, Gerty J de Klerk3,4, Karlijn J van Stralen5. 1. Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands. 2. Department of Epidemiology and Data Science, Amsterdam UMC (Location AMC), University of Amsterdam, Amsterdam, The Netherlands. 3. Department of Oncology, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands. 4. Department of Palliative Care, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands. 5. Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands. KvanStralen@Spaarnegasthuis.nl.
Abstract
PURPOSE: At the end of life, patients and their families tend to favor adequate pain and symptom management and attention to comfort measures over prolongation of life. However, it has been suggested that many cancer patients without curative options still receive aggressive treatment. We therefore aimed to describe the number of diagnostic procedures, hospitalization, and medication use among these patients as well as factors associated with receiving such care. METHODS: We conducted a cohort study on all patients with metastasized cancer from a primary colon or bronchus and lung (BL) neoplasm from the moment of first admittance (January-December 2017) to end of follow-up (November 2018) or death. RESULTS: A total of 408 patients with colon (36%) or BL (64%) cancer were included in this study, with a median survival time of 7.4 months. 93% of the patients were subjected to at least one diagnostic procedure, 49% received chemotherapy, and 56% received expensive medication including immunotherapy. Patients had a median of 4.6 hospital admissions and 2.3 emergency room (ER) visits. A quarter of all patients (n = 105) received specialized palliative care with a mean of 1.96 consultations and the first consultation after a median time of 4.1 months. Patients with BL neoplasms received significantly more diagnostic procedures, chemotherapy episodes, ER/ICU admissions, and more often received an end-of-life statement per person-year than patients with a primary colon neoplasm. Females received significantly less diagnostic procedures and visited the ER/ICU less frequently than males, and patients aged > 70 years received significantly less chemotherapy (episodes) and expensive medication than younger patients. No differences in care were found between different socioeconomic status groups. CONCLUSION: Patients with metastasized colon or BL cancer receive a large amount of in-hospital medical care. Specialized palliative care was initiated relatively late despite the incurable disease status of all patients. Factors associated with more procedures were BL neoplasms, age between 50 and 70, and male gender.
PURPOSE: At the end of life, patients and their families tend to favor adequate pain and symptom management and attention to comfort measures over prolongation of life. However, it has been suggested that many cancerpatients without curative options still receive aggressive treatment. We therefore aimed to describe the number of diagnostic procedures, hospitalization, and medication use among these patients as well as factors associated with receiving such care. METHODS: We conducted a cohort study on all patients with metastasized cancer from a primary colon or bronchus and lung (BL) neoplasm from the moment of first admittance (January-December 2017) to end of follow-up (November 2018) or death. RESULTS: A total of 408 patients with colon (36%) or BL (64%) cancer were included in this study, with a median survival time of 7.4 months. 93% of the patients were subjected to at least one diagnostic procedure, 49% received chemotherapy, and 56% received expensive medication including immunotherapy. Patients had a median of 4.6 hospital admissions and 2.3 emergency room (ER) visits. A quarter of all patients (n = 105) received specialized palliative care with a mean of 1.96 consultations and the first consultation after a median time of 4.1 months. Patients with BL neoplasms received significantly more diagnostic procedures, chemotherapy episodes, ER/ICU admissions, and more often received an end-of-life statement per person-year than patients with a primary colon neoplasm. Females received significantly less diagnostic procedures and visited the ER/ICU less frequently than males, and patients aged > 70 years received significantly less chemotherapy (episodes) and expensive medication than younger patients. No differences in care were found between different socioeconomic status groups. CONCLUSION:Patients with metastasized colon or BL cancer receive a large amount of in-hospital medical care. Specialized palliative care was initiated relatively late despite the incurable disease status of all patients. Factors associated with more procedures were BL neoplasms, age between 50 and 70, and male gender.
Entities:
Keywords:
Cancer; End-of-life care; Pain; Palliative care
Authors: Yvonne de Man; Femke Atsma; Mariska G Oosterveld-Vlug; Linda Brom; Bregje D Onwuteaka-Philipsen; Gert P Westert; A Stef Groenewoud Journal: Cancer Control Date: 2019 Jan-Dec Impact factor: 3.302
Authors: Márton Koch; Csaba Varga; Viktor Soós; Lilla Prenek; Lili Porcsa; Alíz Szakáll; Gergely Bilics; Balázs Hunka; Szabolcs Bellyei; János Girán; István Kiss; Éva Pozsgai Journal: BMC Emerg Med Date: 2022-06-23