title: Aggressiveness of end-of-life care for patients with colorectal cancer in Alberta, Canada: 2006-2009.
abstract: BACKGROUND
  North American studies have documented practice variations and deficiencies in end-of-life (EOL) cancer care, such as trends toward treating dying patients aggressively and disparities in access to palliative care or hospice services.
  
  
  OBJECTIVE
  To assess the frequency of aggressive health care usage at the EOL and identify factors associated with receiving aggressive care among patients who died of colorectal cancer.
  
  
  METHODS
  Data from the Alberta Cancer Registry, in/outpatient hospital records, and cancer electronic medical records were linked. Death in an acute care hospital, chemotherapy use in the last 14 days of life, more than one emergency room (ER) visit, more than one hospital admission, and any intensive care unit (ICU) admission in the last 30 days of life were used as indicators of aggressive care. Logistic regression was used to identify risk factors associated with each indicator.
  
  
  RESULTS
  A total of 2074 patients were included: 50.1% died in an acute care hospital; 3.7% received chemotherapy in the last 14 days of life; and 12.5% had multiple ER visits, 9.5% had multiple hospitalizations, and 2.2% had an ICU admission during the last 30 days of life. Age had the strongest association with chemotherapy use. Geographical region of residence had the strongest association with multiple ER visits and hospitalizations and dying in an acute care hospital. Tumor stage and duration of disease were associated with the ICU admission.
  
  
  CONCLUSIONS
  The percentage of patients who died in an acute care hospital is higher than the 17% U.S. benchmark. Other indicators of receiving aggressive EOL care are consistent with existing care quality benchmarks. The considerable regional variation, however, indicates potential for system improvements.
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Weihong
authors.initials: W
authors.lastname: Hu
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.affiliation: Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: White
authors.affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Cancer Care, Alberta Health Services, Edmonton, Alberta, Canada. Electronic address: marcy.winget@albertahealthservices.ca.
authors.forename: Marcy
authors.initials: M
authors.lastname: Winget
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D000970:Antineoplastic Agents / Q000008:administration & dosage; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000628:therapy*; D003422:Critical Care / Q000639:trends; D004632:Emergency Medical Services / Q000639:trends; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012042:Registries; D012189:Retrospective Studies; D013727:Terminal Care / Q000639:trends; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: End of life; colorectal cancer; health care; quality indicators