Health care utilization at end of life among patients with lung or pancreatic cancer. Comparison between two Swedish cohorts
The purpose was to analyze trends in intensity of care at End-of-life (EOL), in two cohorts of patients with lung or pancreatic cancer. We used population-based registry data on health care utilization to describe proportions and intensity of care at EOL comparing the two cohorts (deceased in the ye...
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| Veröffentlicht in: | PloS one 2021-07, Vol.16 (7), p.e0254673-e0254673 |
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| description | The purpose was to analyze trends in intensity of care at End-of-life (EOL), in two cohorts of patients with lung or pancreatic cancer. We used population-based registry data on health care utilization to describe proportions and intensity of care at EOL comparing the two cohorts (deceased in the years of 2010 and 2017 respectively) in the region of Stockholm, Sweden. A multivariable logistic regression analysis was used for associations. A moderation variable was added to assess for the effect of SPC at home between the cohorts. Intensity of care at EOL increased over time between the cohorts, especially use of SACT, increased with 10%, p |
| doi_str_mv | 10.1371/journal.pone.0254673 |
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Comparison between two Swedish cohorts</title><source>DOAJ Directory of Open Access Journals</source><source>SWEPUB Freely available online</source><source>Public Library of Science (PLoS) Journals Open Access</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Free Full-Text Journals in Chemistry</source><creator>Ullgren, Helena ; Fransson, Per ; Olofsson, Anna ; Segersvärd, Ralf ; Sharp, Lena</creator><contributor>Radfar, Amir</contributor><creatorcontrib>Ullgren, Helena ; Fransson, Per ; Olofsson, Anna ; Segersvärd, Ralf ; Sharp, Lena ; Radfar, Amir</creatorcontrib><description>The purpose was to analyze trends in intensity of care at End-of-life (EOL), in two cohorts of patients with lung or pancreatic cancer. We used population-based registry data on health care utilization to describe proportions and intensity of care at EOL comparing the two cohorts (deceased in the years of 2010 and 2017 respectively) in the region of Stockholm, Sweden. A multivariable logistic regression analysis was used for associations. A moderation variable was added to assess for the effect of SPC at home between the cohorts. Intensity of care at EOL increased over time between the cohorts, especially use of SACT, increased with 10%, p<0.001, (n = 102/754 = 14% to n = 236/972 = 24%), ED visits with 7%, p<0.001, (n = 25/754 = 3% to n = 100/972 = 10%) and ICU care, 2%, p = 0.04, (n = 12/754 = 2% to n = 38/972 = 4%). High intensity of care at EOL were more likely among patients with lung cancer. The difference in use of SACT between the years, was moderated by SPC, with an increase of SACT, unstandardized coefficient [beta]; 0.87, SE = 0.27, p = 0.001, as well as the difference between the years in death at acute care hospitals, that decreased ([beta] = 0.69, SE = 0.26, p = 0.007). These findings underscore an increase of several aspects regarding intensity of care at EOL, and a need for further exploration of the optimal organization of EOL care. Our results indicate fragmentation of care and a need to better organize and coordinate care for vulnerable patients.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0254673</identifier><identifier>PMID: 34270589</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Cancer therapies ; Care and treatment ; Death ; Emergency medical care ; Emergency medical services ; End of life ; Evaluation ; Gender ; Health care ; Health services utilization ; Hospitalization ; Lung cancer ; Lung diseases ; Medical care ; Medical diagnosis ; Medical prognosis ; Medicin och hälsovetenskap ; Medicine and Health Sciences ; Mortality ; Palliative care ; Palliative treatment ; Pancreatic cancer ; Patients ; Radiation therapy ; Regression analysis ; Statistical analysis ; Surgery ; Trends ; Utilization ; Variables</subject><ispartof>PloS one, 2021-07, Vol.16 (7), p.e0254673-e0254673</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Ullgren et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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Comparison between two Swedish cohorts</atitle><jtitle>PloS one</jtitle><date>2021-07-16</date><risdate>2021</risdate><volume>16</volume><issue>7</issue><spage>e0254673</spage><epage>e0254673</epage><pages>e0254673-e0254673</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>The purpose was to analyze trends in intensity of care at End-of-life (EOL), in two cohorts of patients with lung or pancreatic cancer. We used population-based registry data on health care utilization to describe proportions and intensity of care at EOL comparing the two cohorts (deceased in the years of 2010 and 2017 respectively) in the region of Stockholm, Sweden. A multivariable logistic regression analysis was used for associations. A moderation variable was added to assess for the effect of SPC at home between the cohorts. Intensity of care at EOL increased over time between the cohorts, especially use of SACT, increased with 10%, p<0.001, (n = 102/754 = 14% to n = 236/972 = 24%), ED visits with 7%, p<0.001, (n = 25/754 = 3% to n = 100/972 = 10%) and ICU care, 2%, p = 0.04, (n = 12/754 = 2% to n = 38/972 = 4%). High intensity of care at EOL were more likely among patients with lung cancer. The difference in use of SACT between the years, was moderated by SPC, with an increase of SACT, unstandardized coefficient [beta]; 0.87, SE = 0.27, p = 0.001, as well as the difference between the years in death at acute care hospitals, that decreased ([beta] = 0.69, SE = 0.26, p = 0.007). These findings underscore an increase of several aspects regarding intensity of care at EOL, and a need for further exploration of the optimal organization of EOL care. Our results indicate fragmentation of care and a need to better organize and coordinate care for vulnerable patients.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>34270589</pmid><doi>10.1371/journal.pone.0254673</doi><tpages>e0254673</tpages><orcidid>https://orcid.org/0000-0001-5747-853X</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Cancer therapies Care and treatment Death Emergency medical care Emergency medical services End of life Evaluation Gender Health care Health services utilization Hospitalization Lung cancer Lung diseases Medical care Medical diagnosis Medical prognosis Medicin och hälsovetenskap Medicine and Health Sciences Mortality Palliative care Palliative treatment Pancreatic cancer Patients Radiation therapy Regression analysis Statistical analysis Surgery Trends Utilization Variables |
| title | Health care utilization at end of life among patients with lung or pancreatic cancer. Comparison between two Swedish cohorts |
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