title: Palliative care and the aggressiveness of end-of-life care in patients with advanced pancreatic cancer.
abstract: 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.
  
  
  CONCLUSIONS
  PC consultation and a higher intensity of PC were associated with less aggressive care near death in patients with advanced pancreatic cancer.
authors.affiliation: 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.
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Jang
authors.affiliation: 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).
authors.forename: Monika K
authors.initials: MK
authors.lastname: Krzyzanowska
authors.affiliation: 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).
authors.forename: Camilla
authors.initials: C
authors.lastname: Zimmermann
authors.affiliation: 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).
authors.forename: Nathan
authors.initials: N
authors.lastname: Taback
authors.affiliation: 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).
authors.forename: Shabbir M H
authors.initials: SM
authors.lastname: Alibhai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003643:Death; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010166:Palliative Care / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000628:therapy*; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods*; D013997:Time Factors