AGE-DEPENDENCY IN THE AGGRESSIVENESS OF END-OF-LIFE CANCER CARE: A POPULATION-BASED STUDY OF RADIOTHERAPY IN THE LAST 30 DAYS OF LIFE FOR CANCER PATIENTS IN TAIWAN

Sunday, January 10, 2016: 09:00
Kai Chong Tong Auditorium, G/F (Jockey Club School of Public Health and Primary Care Building at Prince of Wales Hospital)

Ya-Chen Tina Shih, PhD1, Chia-Chin Li2, Brian Chiu, PhD3, Ashleigh Guadagnolo, MD4 and Chun-Ru Chien, MD, PhD2, (1)Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, (2)Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan, (3)Department of Public Health Sciences, University of Chicago, Chicago, IL, (4)Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
Purpose: Overly aggressive cancer treatment toward the end of life (EOL) is considered an indicator of poor-quality care. While radiotherapy can be used to alleviate symptoms arising from cancer, prolonged courses of radiotherapy may subject patients to additional harms, higher financial burden, and reduced quality of life. We hypothesized that overly aggressive EOL care is more likely among younger cancer patients.   

Method(s): We defined the duration of EOL as the last 30 days of life and used data from the population-based Taiwan cancer registry linked to Taiwan death registry to construct an EOL study cohort from patients diagnosed with lung, esophageal, and colorectal cancer between 2008 and 2010 and died before December 31, 2012. We identified radiotherapy use from the National Health Insurance claims data. We conducted logistic regression to compare the EOL radiotherapy use between elderly (≥ 65) and non-elderly cancer patients while controlling for cancer type, gender, region, socioeconomic status, comorbidity, and year of death. We compared EOL medical costs between patients with and without radiotherapy; all costs were normalized to 2014 NT dollars and converted to USD via purchasing power parity index. We calculated the proportion of radiotherapy-related costs in total medical costs in EOL and quantified patients whose proportion was at the top 10% percentile as those with overly aggressive EOL radiotherapy and examine the associated factors with logistic regression.

Result(s): Our study cohort consisted of 26954 patients (15226 lung, 3032 esophageal, and 8696 colorectal cancer). EOL radiotherapy use was reported in 7.65% patients, with a higher percentage observed among non-elderly patients (11% vs. 6.15%, P<.0001). Non-elderly patients were more likely to receive EOL radiotherapy after controlling for confounders [adjusted odds ratio (AOR): 1.83, 95% CI 1.66 – 2.02]. Total EOL medical cost was higher among patients who received radiotherapy (Mean: $10410 vs. $6309, P<.0001). Among patients with EOL radiotherapy, overly aggressive care was found to be more common among nonelderly patients in unadjusted (11.74% vs. 8.57%, P=0.017) and adjusted analyses.

Conclusion(s): Our study found younger cancer patients are more susceptible to overly aggressive EOL care, suggesting that communications to initiate early palliative care are especially important among these patients for whom the true prognosis of disease may be masked by the desire to defeat cancer.

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