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Variation in hospital utilization of palliative interventions for patients with advanced gastrointestinal cancer near end of life
Article indépendant
Background: Patients with advanced gastrointestinal (GI) cancer often undergo noncurative interventions with palliative intent to relieve high symptom burden near end of life. Hospital-level variation in intervention utilization remains unclear.
Methods: National cohort study of 142 304 patients with stage III or IV GI cancer within the National Cancer Database (2004–2014) who died within 1-year of diagnosis. Hospitals were stratified by palliative intervention utilization (surgery, chemotherapy, radiation, pain management). Multivariable, multinomial regression evaluated the association between patient/hospital factors and palliative intervention utilization.
Results: Across 1322 hospitals, median hospital palliative intervention utilization was 12.0% [interquartile range: 0.0%–26.1%]. Utilization increased over time in all but lowest utilizing hospitals. Relative to lowest utilizing hospitals, factors associated with a lower likelihood of care at highest utilizing hospitals included: race (White [ref]; Black—Relative Risk Ratio [RRR] 0.81, 95% confidence interval [0.77–0.85]) and lower income (RRR 0.81 [0.78–0.84]). Factors associated with a higher likelihood included: lower education level (RRR 1.62 [1.55–1.69]) and hospital type (community program [ref]; comprehensive community—RRR 1.33 [1.26–1.41]; academic—RRR 1.88 [1.77–1.99]; integrated network—RRR 1.79 [1.66–1.93]).
Conclusion: Hospital variation in palliative intervention use is substantial and potentially associated with sociodemographic and hospital characteristics. Future work can examine how differences in hospital care processes translate to quantity/quality of life for cancer patients.
http://dx.doi.org/10.1002/jso.27177
Voir la revue «Journal of surgical oncology»
Autres numéros de la revue «Journal of surgical oncology»
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