The widespread use of aggressive care at the end of life for nursinghome residents with metastatic cancer suggests the increased emphasis on less intensive care is not getting through, suggests US research. OncTwitter
Aggressive cancer care at the end of life is still common. A new study shows that such care is slightly more likely among patients with metastatic cancer who live in nursing homes than among those who live in the community, although use among both groups is high. The findings suggest that recent messaging about less intensive treatment at the end of life is not getting through, say researchers reporting the findings.
"Despite the increased emphasis on reducing aggressive end-of-life care, such care remains highly prevalent among older persons with metastatic cancer and is more common among nursing home residents than their community-dwelling counterparts," said lead author Siran M. Koroukian, PhD, from the Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Their treatment is"complicated...[by their] high morbidity burden, functional dependency, and/or cognitive impairment." In addition, many will experience treatment-related adverse events, the authors comment. Deaths during the calendar years 2013 to 2017 were evaluated. The 6-month look-back period allowed the investigators to determine comorbid conditions, treatments received, and other health services utilization before death.
The percentage of patients who were eligible for Medicare and Medicaid was higher among nursing home residents than among community dwellers, at 30.4% vs 17.1%, and the proportion of patients with at least five comorbid conditions was far higher among residents, at 75.5% vs 48.8%. On the other hand, nursing home residents were significantly less likely than community dwellers to receive cancer-directed treatment , to be admitted to an intensive care unit , or to be enrolled in a hospice in the last 3 days of life .
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