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Please use this identifier to cite or link to this item: http://hdl.handle.net/11375/32278
Title: End of life interventions in cancer patients
Authors: Webber, Colleen
Hafid, Shuaib
Gayowsky, Anastasia
Howard, Michelle
Tanuseputro, Peter
Jones, Aaron
Scott, Mary
Hsu, Amy T
Downar, James
Manuel, Douglas
Isenberg, Sarina R
Keywords: Neoplasms;Terminal Care;Delivery of Health Care;Health Administrative Data
Publication Date: Apr-2024
Publisher: BMJ Publishing Group
Citation: Webber C, Hafid S, Gayowsky A, Howard M, Tanuseputro P, Jones A, Scott M, Hsu AT, Downar J, Manuel D, Conen K, Isenberg SR. End of life interventions in cancer patients. BMJ Support Palliat Care. 2024:14 (e1), e1432-e1442. doi: 10.1136/spcare-2023-004222.
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 January 1, 2013, and December 31, 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 vs. 19-44 rate ratio (RR) 0.36, 95% confidence interval (CI) 0.34-0.38) and females (RR 0.94, 95% CI 0.93-0.94) had lower intervention rates. Rural patients (RR 1.09, 95% CI 1.08-1.10) individuals in the highest area level income quintile (vs. lowest income quintile RR 1.02, 95% CI 1.01-1.04), and patients with pancreatic cancer (vs. colorectal cancer RR 1.10, 95% CI 1.07-1.12) 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.
URI: http://hdl.handle.net/11375/32278
Appears in Collections:Family Medicine Publications

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