Association of Hospice Care Services With the Utilization of Life-Sustaining Treatments During End-of-Life Care Among Patients With Cancer: A Nationwide 11-Year Cohort Study

Yung-Feng Yen; Yun-Ju Lai; Ming-Chung Ko; Yu-Yen Chen; Yi-Tui Chen; Yi-Sheng Chou; Chun-Teng Huang; Chu-Chieh Chen

doi:10.1016/j.jpainsymman.2020.07.028

Association of Hospice Care Services With the Utilization of Life-Sustaining Treatments During End-of-Life Care Among Patients With Cancer: A Nationwide 11-Year Cohort Study

J Pain Symptom Manage. 2021 Feb;61(2):323-330. doi: 10.1016/j.jpainsymman.2020.07.028. Epub 2020 Jul 30.

Authors

Yung-Feng Yen¹, Yun-Ju Lai², Ming-Chung Ko³, Yu-Yen Chen⁴, Yi-Tui Chen⁵, Yi-Sheng Chou⁶, Chun-Teng Huang⁷, Chu-Chieh Chen⁵

Affiliations

¹ Section of Infectious Diseases, Taipei City Hospital, Taipei, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taiwan. Electronic address: yfyen1@gmail.com.
² School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan; Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan.
³ Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan; Department of Urology, Taipei City Hospital, Taipei, Taiwan.
⁴ Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
⁵ Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
⁶ Department of Hematology and Oncology, Taipei City Hospital, Renai Branch, Taipei, Taiwan.
⁷ Department of Hematology and Oncology, Taipei City Hospital, Yang-Ming Branch, Taipei, Taiwan.

PMID: 32739560
DOI: 10.1016/j.jpainsymman.2020.07.028

Abstract

Context: The impact of hospice care services on the utilization of life-sustaining treatments during end-of-life care in terminally ill patients has not been extensively studied.

Objectives: To determine the impact of hospice care services on the utilization of life-sustaining treatments during the last three months of life among patients with cancer.

Methods: This nationwide population-based cohort study identified adults with cancer diagnosis from the Taiwan Registry for Catastrophic Illness, 2006-2016. Life-sustaining treatments included cardiopulmonary resuscitation, intubation, mechanical ventilation support, nasogastric tube feeding, and total parenteral nutrition. Hospice care services consisted of hospice inpatient care, hospice-shared care, and hospice home care. The association of hospice care services with the utilization of life-sustaining treatments was determined using multiple logistic regression.

Results: Of 516,409 patients with cancer, 310,722 (60.2%) patients used life-sustaining treatments during the last three months of life. After adjusting for covariates, patients with hospice care services were less likely to receive life-sustaining treatments during the last three months of life than those without the services (adjusted odds ratio [AOR]: 0.70; 95% CI: 0.69-0.71). While type of life-sustaining treatments were considered, hospice care services were associated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR: 0.125; 95% CI: 0.118-0.131), endotracheal intubation (AOR: 0.204; 95% CI: 0.199-0.210), mechanical ventilation support (AOR: 0.265; 95% CI: 0.260-0.270), nasogastric tube feeding (AOR: 0.736; 95% CI: 0.727-0.744), and total parenteral nutrition (AOR: 0.86; 95% CI: 0.84-0.88).

Conclusion: Hospice care services were associated with a lower likelihood of receiving life-sustaining treatments during the last three months of life in patients with cancer.

Keywords: Cancer patients; cohort study; hospice care; life-sustaining treatments.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cohort Studies
Hospice Care*
Humans
Neoplasms* / therapy
Taiwan
Terminal Care*