Incidence of Aggressive End-of-Life Care Among Older Adults With Metastatic Cancer Living in Nursing Homes and Community Settings

• DOI: 10.1001/jamanetworkopen.2023.0394
• Publication Date: 2023-02-22T16:01:29Z
• Authors: Siran M. Koroukian; Sara L. Douglas; Long Vu; Hannah L. Fein; Richa Gairola; David F. Warner; Nicholas K. Schiltz; Jennifer Cullen; Cynthia Owusu; Martha Sajatovic; Johnie Rose
• Keywords: Male; Aged, 80 and over; Terminal Care; Incidence; Hospices; Neoplasms, Second Primary; Medicare; United States; 3. Good health; Nursing Homes; Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; Neoplasms; Humans; Female; Hospital Mortality; Child; Original Investigation; Aged

Importance Nearly 10% of the 1.5 million persons residing in nursing homes (NHs) have received or will receive a diagnosis cancer. Although aggressive end-of-life (EOL) care is common among community-dwelling patients with cancer, little known about such patterns NH residents Objective To compare markers EOL between older adults metastatic cancer who are and their counterparts. Design, Setting, Participants This cohort study used Surveillance, Epidemiology, End Results database linked Medicare Minimum Data Set (including clinical assessment data) for deaths occurring from January 1, 2013, to December 31, 2017, 146 329 breast, colorectal, lung, pancreas, prostate lookback period claims data through July 2012. Statistical analysis was conducted March 2021 September 2022. Exposures Nursing home status. Main Outcomes Measures Markers were cancer-directed treatment, intensive unit admission, more than 1 emergency department visit hospitalization last 30 days life, hospice enrollment 3 in-hospital death. The population included 66 years age (mean [SD] age, 78.2 [7.3] years; 51.9% men). Aggressive (63.6% vs 58.3%). status associated 4% higher odds receiving (adjusted ratio [aOR], 1.04 [95% CI, 1.02-1.07]), 6% hospital admission life (aOR, 1.06 1.02-1.10]), 61% dying 1.61 1.57-1.65]). Conversely, lower treatment 0.57 0.55-0.58]), 0.82 0.79-0.84]), 0.89 0.86-0.92]). Conclusions Relevance Despite increased emphasis reduce past several decades, remains slightly prevalent Multilevel interventions decrease should target main factors its prevalence, including admissions