title: Trends in the aggressiveness of end-of-life cancer care in the universal health care system of Ontario, Canada.
abstract: OBJECTIVE
  To describe trends in the aggressiveness of end-of-life (EOL) cancer care in a universal health care system in Ontario, Canada, between 1993 and 2004, and to compare with findings reported in the United States.
  
  
  METHODS
  A population-based, retrospective, cohort study that used administrative data linked to registry data. Aggressiveness of EOL care was defined as the occurrence of at least one of the following indicators: last dose of chemotherapy received within 14 days of death; more than one emergency department (ED) visit within 30 days of death; more than one hospitalization within 30 days of death; or at least one intensive care unit (ICU) admission within 30 days of death.
  
  
  RESULTS
  Among 227,161 patients, 22.4% experienced at least one incident of potentially aggressive EOL cancer care. Multivariable analyses showed that with each successive year, patients were significantly more likely to encounter some aggressive intervention (odds ratio, 1.01; 95% CI, 1.01 to 1.02). Multiple emergency department (ED) visits, ICU admissions, and chemotherapy use increased significantly over time, whereas multiple hospital admissions declined (P < .05). Patients were more likely to receive aggressive EOL care if they were men, were younger, lived in rural regions, had a higher level of comorbidity, or had breast, lung, or hematologic malignancies. Chemotherapy and ICU utilization were lower in Ontario than in the United States.
  
  
  CONCLUSIONS
  Aggressiveness of cancer care near the EOL is increasing over time in Ontario, Canada, although overall rates were lower than in the United States. Health system characteristics and patient or physician cultural factors may play a role in the observed differences.
authors.affiliation: Ontario Institute for Cancer Research, Toronto, Ontario, Canada.
authors.forename: Thi H
authors.initials: TH
authors.lastname: Ho
authors.forename: Lisa
authors.initials: L
authors.lastname: Barbera
authors.forename: Refik
authors.initials: R
authors.lastname: Saskin
authors.forename: Hong
authors.initials: H
authors.lastname: Lu
authors.forename: Bridget A
authors.initials: BA
authors.lastname: Neville
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D016009:Chi-Square Distribution; D003422:Critical Care / Q000639:trends; D004334:Drug Administration Schedule; D004636:Emergency Service, Hospital / Q000639:trends; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000639:trends; D008875:Middle Aged; D009313:National Health Programs / Q000639:trends*; D009369:Neoplasms / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D009864:Ontario; D010166:Palliative Care / Q000639:trends*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018426:SEER Program; D013727:Terminal Care / Q000639:trends*; D013997:Time Factors; D014481:United States; D019472:Universal Health Insurance / Q000639:trends*
chemical_list: D000970:Antineoplastic Agents