Author:
Malhotra Chetna,Bundoc Filipinas,Chaudhry Isha,Teo Irene,Ozdemir Semra,Finkelstein Eric,Dent Rebecca A.,Kumarakulasinghe Nesaretnam Barr,Cheung Yin Bun,Malhotra Rahul,Kanesvaran Ravindran,Yee Alethea Chung Pheng,Chan Noreen,Wu Huei Yaw,Chin Soh Mun,Allyn Hum Yin Mei,Yang Grace Meijuan,Neo Patricia Soek Hui,Harding Richard,Heng Lee Lai,
Abstract
Abstract
Background
Many patients with a solid metastatic cancer are treated aggressively during their last month of life. Using data from a large prospective cohort study of patients with an advanced cancer, we aimed to assess the number and predictors of aggressive interventions during last month of life among patients with solid metastatic cancer and its association with bereaved caregivers’ outcomes.
Methods
We used data of 345 deceased patients from a prospective cohort study of 600 patients. We surveyed patients every 3 months until death for their physical, psychological and functional health, end-of-life care preference and palliative care use. We surveyed their bereaved caregivers 8 weeks after patients’ death regarding their preparedness about patient’s death, regret about patient’s end-of-life care and mood over the last week. Patient data was merged with medical records to assess aggressive interventions received including hospital death and use of anti-cancer treatment, more than 14 days in hospital, more than one hospital admission, more than one emergency room visit and at least one intensive care unit admission, all within the last month of life.
Results
69% of patients received at least one aggressive intervention during last month of life. Patients hospitalized during the last 2–12 months of life, male patients, Buddhist or Taoist, and with breast or respiratory cancer received more aggressive interventions in last month of life. Patients with worse functional health prior to their last month of life received fewer aggressive interventions in last month of life. Bereaved caregivers of patients receiving more aggressive interventions reported feeling less prepared for patients’ death.
Conclusion
Findings suggest that intervening early in the sub-group of patients with history of hospitalization prior to their last month may reduce number of aggressive interventions during last month of life and ultimately positively influence caregivers’ preparedness for death during the bereavement phase.
Trial registration
NCT02850640.
Publisher
Springer Science and Business Media LLC