Background
Methods
Design and setting
Data sources and study population
Measures of intensity of care
Additional data collected from clinical records
Statistical analyses
Results
Study population and patient characteristics per Centre
TOTAL n = 997 | UH 1 n = 200 | CCC 1 n = 200 | UH 2 n = 199 | CCC 2 n = 200 | UH 3 n = 198 | |
---|---|---|---|---|---|---|
Age at death, mean (SD) | 66 (14) | 68 (13) | 64 (14) | 70 (13) | 60 (14) | 70 (13) |
Men, n (%) | 535 (54) | 130 (65) | 42 (21) | 126 (63) | 111 (56) | 126 (64) |
Primary tumor site, n (%) | n = 976 | n = 198 | n = 200 | n = 197 | n = 200 | n = 181 |
Breast | 173 (18) | 12 (6.1) | 106 (53) | 15 (7.6) | 24 (12) | 16 (8.8) |
Lung | 165 (17) | 32 (16) | 27 (14) | 48 (24) | 40 (20) | 18 (9.9) |
Urinary tract and kidney | 136 (14) | 31 (16) | 9 (4.5) | 40 (20) | 19 (9.5) | 37 (20) |
Colorectal | 104 (11) | 21 (11) | 9 (4.5) | 24 (12) | 23 (12) | 27 (15) |
Liver, Pancreas, Biliary tract | 89 (9.1) | 31 (16) | 4 (2.0) | 15 (7.6) | 10 (5.0) | 29 (16) |
Other | 309 (32) | 71 (36) | 45 (23) | 55 (28) | 84 (42) | 54 (30) |
Intensity of end-of-life care
TOTAL | UH 1 | CCC 1 | UH 2 | CCC 2 | UH 3 | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
n | (%) | n | (%) | n | (%) | n | (%) | n | (%) | n | (%) | |
Chemotherapy in last 14 days of life | 116/738 | (15.7) | 15/126 | (11.9) | 30/185 | (16.2) | 21/159 | (13.2) | 42/169 | (24.9) | 8/99 | (8.1) |
Trajectory of care in last month of life | n = 997 | n = 200 | n = 200 | n = 199 | n = 199 | n= 198 | ||||||
1 admission in acute care | 520 | (52.2) | 101 | (50.5) | 92 | (46.0) | 113 | (56.8) | 103 | (51.5) | 111 | (56.1) |
≥ 2 admissions in acute care | 164 | (16.4) | 27 | (13.5) | 35 | (17.5) | 27 | (13.6) | 64 | (32.0) | 11 | (5.6) |
1 emergency visit | 197 | (19.8) | 57 | (28.5) | 11 | (5.5) | 60 | (30.2) | 89 | (44.5) | 41 | (20.7) |
≥ 2 emergency visits | 61 | (6.1) | 9 | (4.5) | 0 |
.
| 13 | (6.5) | 29 | (14.5) | 10 | (5.1) |
≥ 1 admission in Intensive Care Unit | 174 | (17.5) | 35 | (17.5) | 8 | (4.0) | 38 | (19.1) | 23 | (11.5) | 70 | (35.4) |
Patients transferred in palliative care unit | n = 157 | n = 33 | n = 58 | n = 29 | n = 10 | n = 19 | ||||||
≤ 3 days before death | 12 | (7.6) | 0 |
–
| 3 | (5.2) | 6 | (20.7) | 0 |
–
| 3 | (15.8) |
Place of Death | n = 978 | n = 199 | n = 189 | n = 199 | n = 198 | n = 193 | ||||||
Acute care hospital | 672 | (68.7) | 129 | (64.8) | 95 | (50.3) | 139 | (69.8) | 182 | (91.9) | 127 | (65.8) |
Acute care ward | 583 | (59.6) | 113 | (56.8) | 93 | (49.2) | 115 | (57.8) | 146 | (73.7) | 116 | (60.1) |
Intensive Care Unit | 62 | (6.3) | 15 | (7.5) | 2 | (1.1) | 22 | (11.1) | 17 | (8.6) | 6 | (3.1) |
Emergency room | 27 | (2.8) | 1 | (0.5) | 0 | . | 2 | (1.0) | 19 | (9.6) | 5 | (2.6) |
Palliative care unit | 189 | (19.3) | 41 | (20.6) | 60 | (31.7) | 32 | (16.1) | 10 | (5.1) | 46 | (23.8) |
Home | 82 | (8.4) | 24 | (12.1) | 13 | (6.9) | 24 | (12.1) | 4 | (2.0) | 17 | (8.8) |
Other | 35 | (3.6) | 5 | (2.5) | 21 | (11.1) | 4 | (2.0) | 2 | (1.0) | 3 | (1.6) |
Impact of palliative care on intensity of end-of-life care
TOTAL | UH 1 | CCC 1 | UH 2 | CCC 2 | UH 3 | |
---|---|---|---|---|---|---|
Study centre is referent for the patient’s cancer, n/total (%) | 842/932 (90) | 181/200 (91) | 196/200 (98) | 163/199 (82) | 187/200 (94) | 115/133 (87) |
Anteriority of follow up in the centre, Median time in months (Q1 - Q3) |
12 (4–37)
| 10 (4–24) |
33 (9–106)
| 8 (3–21) |
17 (6–43)
| 8 (2–21) |
Intervention by the Palliative Care Team, n/total (%) | 492/926 (53) | 101/196 (52) | 140/199 (70) | 59/196 (30) | 112/199 (56) | 81/136 (60) |
ECOG PS at 1st intervention ≤2 | 95/349 (27) | 23/67 (34) | 43/83 (52) | 5/21 (24) | 12/101 (12) | 12/77 (16) |
Time between first intervention and date of death | n = 475 | n = 98 | n = 138 | n = 55 | n = 107 | n = 77 |
≤ 7 days | 81 (17) | 12 (12) | 10 (2, 7) | 10 (18) | 32 (30) | 17 (22) |
]7–30] days | 117 (25) | 15 (15) | 19 (14) | 22 (40) | 35 (33) | 26 (34) |
]30–90] days | 128 (27) | 39 (40) | 31 (23) | 14 (26) | 24 (22) | 20 (26) |
> 90 days | 149 (31) | 32 (33) | 78 (57) | 9 (16) | 16 (15) | 14 (18) |
median (Q1 - Q3) | 41 (13–122) | 63 (25–115) | 112 (38–281) | 25 (11–50) | 17 (7–54) | 21 (8–64) |
Early intervention of PCT (> 30 days before death) | No or late intervention of PCT (< 30 days before death) | Multivariable analysisa | |||||
---|---|---|---|---|---|---|---|
Indicators | n | (%) | n | (%) | OR | IC95% | p-value |
Chemotherapy in last 14 days of life | 28/240 | (11.7) | 89/487 | (18.3) | 0.50 | [0.30–0.82] | 0.006 |
≥ 1 emergency visits | 62/282 | (22.0) | 188/644 | (29.2) | 1.04 | [0.72–1.49] | 0.844 |
≥ 1 admission in ICU | 49/282 | (17.4) | 114/644 | (17.7) | 1.45 | [0.95–2.21] | 0.082 |
≥ 1 admission in acute care | 180/282 | (63.8) | 481/644 | (74.7) | 0.64 | [0.46–0.89] | 0.009 |
Place of death in acute care hospital | 153/273 | (56.0) | 511/637 | (80.2) | 0.33b | [0.23-0.47] | < 0.0001 |