TY - JOUR
T1 - Use of palliative chemotherapy and icu admissions in gastric and esophageal cancer patients in the last phase of life: A nationwide observational study
AU - Besseling, Joost
AU - Reitsma, Jan
AU - van Erkelens, Judith A.
AU - Schepens, Maike H. J.
AU - Siroen, Michiel P. C.
AU - Ziedses des Plantes, Cathelijne M. P.
AU - van Berge Henegouwen, Mark I.
AU - Beerepoot, Laurens V.
AU - Voorthuizen, Theo Van
AU - Zuylen, Lia Van
AU - Verhoeven, Rob H. A.
AU - van Laarhoven, Hanneke
N1 - Funding Information: Conflicts of Interest: M.I.v.B.H. reports grants from Olympus, grants and nonfinancial support from Stryker, Johnson and Johnson, Mylan, Medtronic (all outside the submitted work and all fees paid to institution); T.V.V. reports nonfinancial support from Pfizer, Ipsen, and Astellas (all outside the submitted work); R.V. reports grants from Roche and Bristol-Myers Squibb (all outside the submitted work); H.v.L. reports grants, personal fees, and nonfinancial support from Bristol-Myers Squibb, Nordic Pharma, Servier, and Lilly, personal fees from MSD, and grants and nonfinancial support from Bayer, Celgene, Janssen, Merck, Phillips, and Roche outside the submitted work. J.B., J.R., J.V.E., M.S. (M.H.J. Schepens), L.Z., and L.V.B. declare no competing interests. Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - Since intensive care unit (ICU) admission and chemotherapy use near death impair the quality of life, we studied the prevalence of both and their correlation with hospital volume in incurable gastroe-sophageal cancer patients as both impair the quality of life. We analyzed all Dutch patients with incurable gastroesophageal cancer who died in 2017–2018. National insurance claims data were used to determine the prevalence of ICU admission and chemotherapy use (stratified on previous chemotherapy treatment) at three and one month(s) before death. We calculated correlations between hospital volume (i.e., the number of included patients per hospital) and both outcomes. We included 3748 patients (mean age: 71.4 years; 71.4% male). The prevalence of ICU admission and chemotherapy use were, respectively, 5.6% and 21.2% at three months and 4.2% and 8.0% at one month before death. Chemotherapy use at three and one months before death was, respectively, 4.3 times (48.0% vs. 11.2%) and 3.7 times higher (15.7% vs. 4.3%), comparing patients with previous chemotherapy treatment to those without. Hospital volume was negatively correlated with chemotherapy use in the final month (rweighted = −0.23, p = 0.04). ICU admission and chemotherapy use were relatively infrequent. Oncologists in high-volume hospitals may be better equipped in selecting patients most likely to benefit from chemotherapy.
AB - Since intensive care unit (ICU) admission and chemotherapy use near death impair the quality of life, we studied the prevalence of both and their correlation with hospital volume in incurable gastroe-sophageal cancer patients as both impair the quality of life. We analyzed all Dutch patients with incurable gastroesophageal cancer who died in 2017–2018. National insurance claims data were used to determine the prevalence of ICU admission and chemotherapy use (stratified on previous chemotherapy treatment) at three and one month(s) before death. We calculated correlations between hospital volume (i.e., the number of included patients per hospital) and both outcomes. We included 3748 patients (mean age: 71.4 years; 71.4% male). The prevalence of ICU admission and chemotherapy use were, respectively, 5.6% and 21.2% at three months and 4.2% and 8.0% at one month before death. Chemotherapy use at three and one months before death was, respectively, 4.3 times (48.0% vs. 11.2%) and 3.7 times higher (15.7% vs. 4.3%), comparing patients with previous chemotherapy treatment to those without. Hospital volume was negatively correlated with chemotherapy use in the final month (rweighted = −0.23, p = 0.04). ICU admission and chemotherapy use were relatively infrequent. Oncologists in high-volume hospitals may be better equipped in selecting patients most likely to benefit from chemotherapy.
KW - End of life
KW - Gastroesophageal cancer
KW - Nationwide
KW - Palliative care
UR - http://www.scopus.com/inward/record.url?scp=85099964590&partnerID=8YFLogxK
U2 - https://doi.org/10.3390/cancers13010145
DO - https://doi.org/10.3390/cancers13010145
M3 - Article
C2 - 33466279
SN - 2072-6694
VL - 13
SP - 1
EP - 10
JO - Cancers
JF - Cancers
IS - 1
M1 - 145
ER -