There is growing concern in society about aggressiveness of cancer care near the end of life (ACCEoL), mainly in metastatic disease. This study aims to determine prevalence and recent time trend of ACCEoL of adult cancer patients in a European country, comparing metastatic with others.
Cohort study of adults with ICD-9-CM diagnosis of cancer, who died in public hospitals in mainland Portugal (Jan’10 - Dec’15), identified from the Hospital Morbidity database (HMD). HMD provided data on primary cancer site, presence of metastatic disease and primary outcome: a composite ACCEoL indicator aggregating presence of 1 of 14 individual indicators in the last 30 days of life or chemo, immunotherapy or biological agents in the last 14 days of life (expansion of Earle et al 2004 framework). We calculated the prevalence of composite and individual indicators and examined time trends (chi2 test for trend) for the whole cohort, in metastatic disease and for main primary cancers. We considered clinically meaningful > 5% change.
92,155 patients were included (median age 73 yo, IQR 62-81; 61.9% male; 53.0% metastatic). The prevalence of the ACCEoL was 71.1%, 69.9% in metastatic patients vs. 72.6% in others (p 5% change.
Surprisingly, we found unchanged trends of high ACCEoL among adult patients and no clinically meaningful difference for metastatic disease group. A lack of integrated palliative care, even with growing resources in the timeframe analysed, suggest that these have not been enough to reduce ACCEoL. The reduced ACCEoL in patients who died with slow progressive cancers (e.g. breast) suggests that better knowledge of disease trajectories can contribute towards reducing ACCEoL.
Clinical trial identification
Legal entity responsible for the study
Calouste Gulbenkian Foundation, Liga Portuguesa Contra o Cancro - Núcleo Regional do Sul
All authors have declared no conflicts of interest.