Cancer patients living in nursing homes are more likely to receive aggressive end-of-life care, according to a study published in JAMA Network Open.
Researchers found that nursing home residents with cancer were more likely than community-dwelling cancer patients to be admitted to the hospital in their last 30 days and to die in the hospital.
The researchers evaluated data from 146,329 patients with metastatic cancer from the Surveillance, Epidemiology, and End Results database linked with the Medicare database and the Minimum Data Set.
Overall, 28.0% of the patients were nursing home residents. The median age of the cohort was 77 (range, 72-84) years. The most common cancer type was lung (45.2%), followed by colorectal (15.8%), prostate (15.5%), pancreatic (12.9%), and breast (10.6%).
Aggressive end-of-life care was defined as having any of the following markers in the last 30 days of life: any cancer-directed treatment (including surgery, radiotherapy, or chemotherapy), more than 1 emergency department visit, more than 1 hospital admission, and any intensive care unit (ICU) admission. Aggressive end-of-life care also included hospice entry in the last 3 days of life and death in the hospital.
In total, 63.6% of nursing home residents received aggressive end-of-life care, as did 58.3% of community-dwelling residents.
In a multivariable analysis, nursing home residence was associated with higher odds of:
- Receiving aggressive end-of-life care (adjusted odds ratio [aOR], 1.04; 95% CI, 1.02-1.07)
- Having more than 1 hospital admission in the last 30 days of life (aOR, 1.06; 95% CI, 1.02-1.10)
- Dying in the hospital (aOR, 1.61; 95% CI, 1.57-1.65).
On the other hand, nursing home residence was associated with lower odds of:
- Receiving cancer-directed treatment in the last 30 days of life (aOR, 0.57; 95% CI, 0.55-0.58)
- Being admitted to the ICU (aOR, 0.82; 95% CI, 0.79-0.84)
- Enrolling in hospice in the last 3 days of life (aOR, 0.89; 95% CI, 0.86-0.92).
Nursing home residence was not significantly associated with more than 1 emergency department visit (aOR, 0.97; 95% CI, 0.95-1.00).
“Despite increased emphasis to reduce aggressive EOL [end-of-life] care in the past several decades, such care remains common among older persons with metastatic cancer and is slightly more prevalent among NH [nursing home] residents than their community-dwelling counterparts,” the researchers wrote. “Multilevel interventions to decrease aggressive EOL care should target the main factors associated with its prevalence, including hospital admissions in the last 30 days of life and in-hospital death.”
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Koroukian SM, Douglas SL, Vu L, et al. Incidence of aggressive end-of-life care among older adults with metastatic cancer living in nursing homes and community settings. JAMA Netw Open. Published online February 22, 2023. doi:10.1001/jamanetworkopen.2023.0394