title: End-of-life care in a population-based cohort of cancer patients: clinical trial participation versus standard of care.
abstract: OBJECTIVE
  To evaluate end-of-life care in a cohort of oncology patients in Olmsted County, Minnesota, USA, and compare differences between patients participating in clinical trials and those not in clinical trials.
  
  
  METHODS
  A population-based cohort of subjects with active oncological disease who died between 2000 and 2002 was constructed retrospectively using institutional databases. Clinical trial participation and care during the last 2 months of life were analysed.
  
  
  RESULTS
  A total of 395 eligible patients were identified. In the 2 months prior to death, 94 (24%) patients received chemotherapy, 232 (59%) were hospitalised, 249 (63%) were in hospice and 315 (80%) had a do not resuscitate (DNR) code status. Only 8 (2%) patients received cardiopulmonary resuscitation (CPR) and 26 (7%) patients participated in a clinical trial. Patients in clinical trials were more likely to receive chemotherapy (69.2% vs 20.6%; p<0.001), undergo intubation/mechanical ventilation (15.4% vs 5.4%; p=0.040) and less likely to have DNR code status (50.0% vs 81.8%; p<0.001) when compared with patients not in clinical trials. However, no differences in hospice enrolment, days in hospice, days in the hospital, CPR or location of death were noted.
  
  
  CONCLUSIONS
  Although opportunities for improvement exist, high quality end-of-life care was found in this study of patients with active malignancy. A majority (over 60%) of patients enrolled in hospice prior to death, 80% had a DNR status and only 2% received CPR. Although clinical trial participants received more aggressive treatments during the last 2 months of life, they did not appear to have lower quality end-of-life care.
authors.affiliation: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Carrie A
authors.initials: CA
authors.lastname: Thompson
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Hugo
authors.forename: Keith Mark
authors.initials: KM
authors.lastname: Swetz
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Novotny
authors.forename: Jeff A
authors.initials: JA
authors.lastname: Sloan
authors.forename: Charles L
authors.initials: CL
authors.lastname: Loprinzi
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Moynihan
authors.forename: Tait D
authors.initials: TD
authors.lastname: Shanafelt
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D017051:Hospice Care / Q000592:standards / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008910:Minnesota; D009369:Neoplasms / Q000188:drug therapy / Q000628:therapy*; D010166:Palliative Care / Q000592:standards / Q000706:statistics & numerical data*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D016414:Resuscitation Orders; D012189:Retrospective Studies; D059039:Standard of Care / Q000592:standards / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000592:standards / Q000706:statistics & numerical data*
keywords: Cancer; Hospice Care; Terminal Care