title: Determinants for aggressive end-of-life care for oral cancer patients: a population-based study in an Asian country.
abstract: Few studies have addressed the association between oral cancer and end-of-life (EOL) aggressive care using population data. We investigated the relationship between patient demographics, primary physician's specialty, and hospital characteristics of patients who died from oral cancer in Taiwan from 2009 to 2011 and the aggressiveness of their EOL care. This nationwide population-based, retrospective cohort study identified 5386 patients who died from oral cancer identified from Taiwan's National Register of Deaths Database and collected their claims data from Taiwan's National Health Insurance Research Database. Accepted indicators of aggressiveness of EOL care were examined using a composite measure adapted from Earle et al. Scores ranged from 0 to 6; the higher the score, the more aggressive the EOL care. The impact of each variable on the aggressiveness of EOL care was examined by multivariate analysis using a random-intercept model. The mean composite score for aggressiveness of EOL care was 2.68 ± 1.37. Oral cancer patients who were younger, had a higher level of comorbidity or metastasis, belonged to a lower-level individual socioeconomic status, were cared for by nononcologists, had longer postdiagnosis survival times, or resided in urban areas were more likely to receive aggressive care at EOL. Compared with previous studies, oral cancer patients near death in this nationwide study had a far higher utilization rate (>50%) of chemotherapy, emergency room services, and intensive care unit services. Our findings indicate that oral cancer patients receive extensive aggressive medical care at EOL. Future research may be needed to examine the effect of the means (indicators) of aggressive treatment on survival, quality of life, and medical costs, especially since current research suggests such care may adversely affect quality of life and important preparation of death in these patients.
authors: From the Department of Otolaryngology (T-SC), Kaohsiung Veterans General Hospital, Kaohsiung; Institute of Public Health (T-SC), College of Medicine, National Cheng Kung University, Tainan; National Defense Medical Center (T-SC), Taipei; Department of Otolaryngology (C-CL); Department of Internal Medicine (Y-CS); Cancer Center (C-CL), Buddhist Dalin Tzu Chi General Hospital, Chiayi; and School of Medicine (Y-CS, C-CL), Tzu Chi University, Hualian, Taiwan.
authors: Ting-Shou
authors: TS
authors: Chang
authors: Yu-Chieh
authors: YC
authors: Su
authors: Ching-Chih
authors: CC
authors: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D015331:Cohort Studies; D015897:Comorbidity; D004363:Drug Utilization; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000401:mortality* / Q000628:therapy; D012042:Registries; D012189:Retrospective Studies; D012424:Rural Population; D012923:Social Class; D013624:Taiwan / Q000453:epidemiology; D013727:Terminal Care / Q000379:methods / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
references: J Clin Oncol. 2009 Sep 20;27(27):4613-8
references: 19704067
references: Eur J Cancer. 2013 Oct;49(15):3284-91
references: 23756054
references: Eur J Health Econ. 2004 Feb;5(1):70-80
references: 15452768
references: Ann Oncol. 2010 Oct;21 Suppl 7:vii252-61
references: 20943624
references: J Oral Pathol Med. 2005 Nov;34(10):596-601
references: 16202079
references: JAMA. 2012 Mar 14;307(10):1037-45
references: 22416099
references: J Clin Oncol. 2006 Jul 20;24(21):3490-6
references: 16849766
references: Ann Oncol. 2009 Feb;20(2):343-8
references: 18765460
references: JAMA. 2008 Jun 11;299(22):2667-78
references: 18544726
references: J Clin Oncol. 2008 Aug 10;26(23):3860-6
references: 18688053
references: Oral Oncol. 2009 Apr-May;45(4-5):309-16
references: 18804401
references: Surgery. 2008 Mar;143(3):343-51
references: 18291255
references: J Clin Oncol. 2003 Mar 15;21(6):1133-8
references: 12637481
references: J Clin Epidemiol. 1992 Jun;45(6):613-9
references: 1607900
references: N Engl J Med. 2007 Oct 25;357(17):1695-704
references: 17960012
references: Arch Otolaryngol Head Neck Surg. 2004 Nov;130(11):1269-75
references: 15545580
references: J Clin Oncol. 2011 Jun 10;29(17):2319-26
references: 21555700
references: J Clin Oncol. 2004 May 1;22(9):1743-52
references: 15117998
references: Eur J Cancer Prev. 2004 Apr;13(2):139-42
references: 15100581
references: Palliat Med. 2012 Jan;26(1):80-8
references: 21606128
references: J Clin Oncol. 2011 Apr 20;29(12):1587-91
references: 21402603
references: N Engl J Med. 2008 Sep 11;359(11):1116-27
references: 18784101
references: PLoS One. 2013 Sep 12;8(9):e73889
references: 24069242
references: Oral Oncol. 2012 Sep;48(9):898-904
references: 22502815
references: Diabetes Care. 2004 Jul;27(7):1605-9
references: 15220235
references: Semin Respir Crit Care Med. 2012 Aug;33(4):362-9
references: 22875382
references: J Clin Oncol. 2012 Aug 1;30(22):2715-7
references: 22753911
references: J Natl Cancer Inst. 2011 Jun 8;103(11):853-62
references: 21593012
references: J Clin Oncol. 2004 Jan 15;22(2):315-21
references: 14722041
references: CA Cancer J Clin. 2005 Mar-Apr;55(2):74-108
references: 15761078
references: J Clin Oncol. 2012 Dec 10;30(35):4387-95
references: 23150700
references: Psychosomatics. 1988 Fall;29(4):392-7
references: 3227094
references: J Clin Oncol. 2005 Aug 20;23(24):5568-77
references: 16009950
references: BMC Palliat Care. 2011 Sep 21;10:14
references: 21936940
references: Cancer. 2011 Apr 1;117(7):1506-15
references: 21425152
references: Chest. 2008 Jan;133(1):72-8
references: 17989164
references: BMJ. 2003 Jul 26;327(7408):192-4
references: 12881259
references: BMJ. 2000 Feb 19;320(7233):469-72
references: 10678857
references: J Pain Symptom Manage. 2007 Aug;34(2):120-5
references: 17583469
references: BMJ. 1994 Apr 9;308(6934):961-6
references: 8173406