Indicators of poor quality end-of-life cancer care in Ontario

J Palliat Care. Spring 2006;22(1):12-7.

Abstract

This study measures the proportion of cancer patients in Ontario, Canada, with intensive care unit (ICU) admissions, emergency room (ER) visits, or chemotherapy in the last two weeks of life. We used the Ontario Cancer Registry to identify a cohort of cancer patients who died in 2001. These cases were then linked to administrative sources of data to measure each indicator, and to describe the associated clinical and health service factors. In the cohort, 27% had at least one ER visit and 5% had an ICU visit in the last two weeks of life. Of those who received chemotherapy in the last six months, 16% received chemotherapy in the last two weeks of life. Receiving a home care visit in the last six months of life, or a physician house call or a palliative care assessment in the last two weeks of life was consistently associated with decreased odds of each of the indicators. Our results indicate that a significant proportion of Ontario cancer patients have indicators of poor quality end-of-life care. Certain health care factors may influence these indicators.

MeSH terms

  • Aged
  • Antineoplastic Agents / therapeutic use
  • Cause of Death
  • Community Health Planning
  • Comorbidity
  • Critical Care / organization & administration
  • Emergency Service, Hospital / organization & administration
  • Female
  • Health Services Research
  • House Calls / statistics & numerical data
  • Humans
  • Income / statistics & numerical data
  • Logistic Models
  • Male
  • Medical Oncology / organization & administration*
  • Middle Aged
  • Multivariate Analysis
  • Neoplasms / diagnosis
  • Neoplasms / mortality
  • Neoplasms / therapy*
  • Ontario / epidemiology
  • Patient Admission / statistics & numerical data
  • Quality Indicators, Health Care / organization & administration*
  • Registries
  • Residence Characteristics / statistics & numerical data
  • Retrospective Studies
  • Terminal Care / organization & administration*

Substances

  • Antineoplastic Agents