Emergency department use at the end of life in elderly patients with gastrointestinal malignancies and mental health comorbidities.

• DOI: 10.1200/jco.2020.38.4_suppl.811
• Publication Date: 2020-02-04T21:41:51Z
• Authors: Mehr Kashyap; Jeremy Phillip Ha...; Daniel Tandel Chang; Erqi L. Pollom
• Keywords: Depression; End-of-Life Care

811 Background: Aggressive care at the end-of-life can contradict patients’ wishes, negatively impact patient quality of life, and contribute to overall health expenditures. Patients with mental disorders (MD) often experience disparities in medical have poorer clinical outcomes. We investigated on emergency department (ED) use end life among elderly patients gastrointestinal (GI) malignancies. Methods: conducted a retrospective cohort study using SEER-Medicare database. identified aged 66 years older GI malignancies (colorectal, pancreatic, gastric, hepatic, biliary, esophageal, small bowel, anal cancer) diagnosed between 2004 2013 who had recorded death. assessed association MD (depression, bipolar disorder, psychotic anxiety, dementia, substance abuse) ED within 30 days death logistic regression models. Results: Of 160,367 decedents included, 54,461 (34.1%) least one diagnosis year prior cancer Those were more likely than once last (14.7% vs. 12.4% p < 0.01). was highest anxiety disorder (15.8%) abuse (16.3%). Among disorders, risk factors associated include being male (adjusted odds ratio [aOR] 1.16, 95% confidence interval [CI] 1.10 – 1.22), younger (aOR 1.14, CI 1.06 - 1.23), black 1.33, 1.23 1.45), living lower income zip code (1.21, 1.13 1.30), having higher Charlson comorbidity score 1.71, 1.56 1.87). also pancreatic 1.08 1.25), hepatic 1.21, 1.11 1.33), biliary 1.03 1.30) esophageal 1.04 1.29) compared colorectal cancer. Conclusions: is increased Palliative supportive including services early disease course may improve this vulnerable population.