Health Services Research

PV QA 3 - Poster Viewing Q&A 3

TU_40_2990 - Quality of End of Life Care Among Metastatic Cancer Patients Receiving Radiation Therapy

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Quality of End of Life Care Among Metastatic Cancer Patients Receiving Radiation Therapy
K. Sborov1, S. Giaretta1, A. Koong1, S. Aggarwal2, R. Von Eyben1, D. T. Chang2, M. F. Gensheimer1, and E. Pollom3; 1Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA, 2Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, 3Stanford Cancer Institute, Stanford, CA

Purpose/Objective(s): Patients with advanced cancer receive aggressive care at the end of life despite evidence that high-intensity treatments do not improve quality of life or disease outcomes. We characterized quality of end of life care and determined factors associated with this care among patients with metastatic cancer treated with radiation therapy (RT).

Materials/Methods: We used data from an IRB-approved, prospective cohort study examining the ability of health care personnel to predict survival of patients with metastatic cancer receiving palliative RT in our department. For decedents in this cohort, we examined markers of intensive end of life care as defined by the National Quality Forum (NQF) and ASCO Quality Oncology Practice Initiative (QOPI) quality measures: receipt of chemotherapy in the last 14 days of life, presence of several markers in the last 30 days of life (intensive care unit (ICU) stay, 2 or more emergency room (ER) or hospital admissions, use of advanced radiation technologies), in-hospital death, and referral to hospice 3 days before death. We determined the association between clinical factors and quality of end of life care using chi-square test and logistic regression models.

Results: We identified 489 decedents with median survival from time of study enrollment of 5.2 months (95% confidence interval 4.4-5.8). Median age was 66 (interquartile range 56-73) and 246 (50.3%) were female. Primary cancer sites included lung (n=135), GI (n=103), breast (n=63), head & neck/skin (n=59), prostate/GU (n=53), and other (n=76). Additionally, 248 (50.7%) had brain metastases. Overall, 156 (31.9%) decedents met at least 1 NQF/QOPI metric of intense end of life care. Of these, 52 (10.6%) had >1 ER visit, 58 (11.9%) had >1 hospital admission, 34 (7.0%) were in the ICU, 70 (14.3%) died in the hospital, 23 (4.7%) were referred to hospice 3 days before death, and 18 (3.7%) received chemotherapy shortly before death. A total of 114 (23.3%) patients received RT at the end of life, 54 (11.0%) of whom were treated with advanced RT techniques (i.e. intensity-modulated or stereotactic body RT or radiosurgery). Factors associated with meeting at least 1 metric of intense end of life care included: younger age (p=0.002), female sex (p=0.04), a primary breast cancer diagnosis (p=0.04), or presence of brain metastases (p=0.03). There was a trend for worse performance status being associated with intense end of life care (p=0.09). In a multivariate model, worse performance status at time of study enrollment and younger age were significantly associated with intense end of life care (p=0.05 and p=0.04, respectively).

Conclusion: We found that a third of patients with metastatic cancer who received palliative RT had intense end of life care. With increasing scrutiny into the value of healthcare, there is an opportunity for radiation oncologists to play an important role in guiding care at the end of life for patients with metastatic cancer.

Author Disclosure: K. Sborov: None. S. Giaretta: None. A. Koong: None. R. Von Eyben: None. D.T. Chang: Research Grant; Varian Medical Systems. Stock; ViewRay. M.F. Gensheimer: Research Grant; Varian Medical Systems, Philips Healthcare.

Kate Sborov, BS

Disclosure:
Employment
Stanford University Cancer Center: Assistant Clinical Research Coordinator: Employee

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