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Medline ® Abstract for Reference 39

of 'Benefits, services, and models of subspecialty palliative care'

Palliative care and the aggressiveness of end-of-life care in patients with advanced pancreatic cancer.
Jang RW, Krzyzanowska MK, Zimmermann C, Taback N, Alibhai SM
J Natl Cancer Inst. 2015;107(3)
BACKGROUND: We examined the impact of palliative care (PC) on aggressiveness of end-of-life care for patients with advanced pancreatic cancer. Measures of aggressive care included chemotherapy within 14 days of death; and at least one intensive care unit (ICU) admission, more than one emergency department (ED) visit, and more than one hospitalization, all within 30 days of death.
METHODS: A retrospective population-based cohort study using administrative data was conducted in patients with advanced pancreatic cancer from 2005 to 2010 in Ontario, Canada. Multivariable logistic regression was performed with the above measures of aggressive care as the outcomes of interest and PC as the main exposure, adjusting for covariables. Secondary analyses examined intensity of PC as the main exposure defined in two ways: 1) absolute number of PC visits before the outcome of interest (0, 1, 2, 3+ visits) and 2) monthly rate of PC visits.
RESULTS: The cohort included 5381 patients (median survival 75 days); 2816 (52.3%) had received a PC consultation. PC consultation was associated with decreased use of chemotherapy near death (odds ratio [OR]= 0.34, 95% confidence interval [CI]= 0.25 to 0.46); lower risk of ICU admission: OR = 0.12, 95% CI = 0.08 to 0.18; multiple ED visits: OR = 0.19, 95% CI = 0.16 to 0.23; multiple hospitalizations near death: OR = 0.24, 95% CI = 0.19 to 0.31). A per-unit increase in the monthly rate of PC visits was associated with lower odds of aggressive care for all four outcomes.
CONCLUSION: PC consultation and a higher intensity of PC were associated with less aggressive care near death in patients with advanced pancreatic cancer.
Division of Medical Oncology and Hematology (RWJ, MKK) and Department of Psychosocial Oncology and Palliative Care (CZ), Princess Margaret Cancer Centre/University Health Network, Toronto, Canada (RWJ, MKK); Department of Medicine (RWJ, MKK, CZ, SMHA), Institute of Medical Sciences (MKK, CZ, SMHA), Division of Biostatistics, Dalla Lana School of Public Health (NT), and Institute of Health Policy, Management, and Evaluation (MKK, SMHA), University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada (MKK). raymond.jang@uhn.ca.