Palliative care needs of cancer patients in U.S. nursing homes.
BACKGROUND
Increasingly, nursing homes are the place of care for older Americans with cancer. Yet, few studies has characterized the quality of care for this growing population.


OBJECTIVE
Characterize the scope and quality of cancer care in U.S. nursing homes.


METHODS
Secondary analysis of the national repository of the Minimum Data Set (MDS) SETTING AND SUBJECTS: Nursing home residents noted to have cancer diagnosis on the MDS.


RESULTS
Of the 190,769 New Hampshire residents (8.8%) with a cancer diagnosis, 1 in 4 had weight loss (23.4%), received intravenous medications (27.7%), or used oxygen (25.4%). Overall, 45.3% had a do-not-resuscitate (DNR) order, with state variations ranging from 17.8% (New Jersey) to 70.5% (Wisconsin). More than 1 in 10 (12.0%) were defined as terminally ill, although only 29.3% of these received hospice services. Among patients with pain, half of those who survived to a second assessment had persistent, severe pain (51.3%), which also varied by state, ranging from 43.3% (Iowa) to 65.8% (Nevada). Active treatment was rare; less than 5% received chemotherapy or radiotherapy. However, 15.5% had parenteral and/or tube feedings for nutrition. Approximately, 1 in 10 New Hampshire residents had advanced cancer.


CONCLUSIONS
Our findings suggest important opportunities to improve the quality of cancer care for older adults.
Johnson
Vanessa M P
VM
Oncology and Hematology Associates, New London, Connecticut, USA.
Teno
Joan M
JM
Bourbonniere
Meg
M
Mor
Vincent
V
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D009735:Nursing Homes / Q000706:statistics & numerical data*; D059408:Pain Management; D010166:Palliative Care / Q000592:standards / Q000706:statistics & numerical data*; D011787:Quality of Health Care