Affordable Access

deepdyve-link
Publisher Website

Potentially burdensome end-of-life transitions among nursing home residents with poor-prognosis cancer.

Authors
  • Lage, Daniel E1
  • DuMontier, Clark2, 3
  • Lee, Yoojin4, 5
  • Nipp, Ryan D1
  • Mitchell, Susan L3
  • Temel, Jennifer S1
  • El-Jawahri, Areej1
  • Berry, Sarah D3
  • 1 Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts.
  • 2 Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
  • 3 Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife and Harvard Medical School, Boston, Massachusetts.
  • 4 Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island.
  • 5 Center for Gerontology, Brown University School of Public Health, Providence, Rhode Island.
Type
Published Article
Journal
Cancer
Publisher
Wiley (John Wiley & Sons)
Publication Date
Mar 15, 2020
Volume
126
Issue
6
Pages
1322–1329
Identifiers
DOI: 10.1002/cncr.32658
PMID: 31860129
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

This study examined factors associated with potentially burdensome end-of-life (EOL) transitions between care settings among older adults with advanced cancer in nursing homes (NHs). A retrospective analysis of deceased older NH residents with poor-prognosis solid tumors was conducted with Medicare claims and the Minimum Data Set. A potentially burdensome transition was defined as 2 or more hospitalizations or an intensive care unit admission in the last 90 days of life. Among 34,670 subjects, many had moderate to severe cognitive impairment (53.8%), full dependence in activities of daily living (ADLs; 66.5%), and comorbidities such as congestive heart failure (CHF; 29.3%) and chronic obstructive pulmonary disease (34.1%). Only 56.3% of the patients used hospice at any time in the 90 days before death; 36.0% of the patients experienced a potentially burdensome EOL transition, and this was higher among patients who did not receive hospice (45.4% vs 28.7%; P < .01). In multivariable analyses, full dependence in ADLs (odds ratio [OR], 1.70; P < .01), CHF (OR, 1.48; P < .01), and chronic obstructive pulmonary disease (OR, 1.28; P < .01) were associated with a higher risk of burdensome EOL transitions. Those with do-not-resuscitate directives (OR, 0.60; P < .01) and impaired cognition (OR, 0.89; P < .01) had lower odds of burdensome EOL transitions. NH residents with advanced cancer have substantial comorbidities and functional impairment, yet more than a third experience potentially burdensome EOL transitions. These findings help to identify a population at risk for poor EOL outcomes in order to target interventions, and they point to the importance of advanced care planning in this population. © 2019 American Cancer Society.

Report this publication

Statistics

Seen <100 times