title: Factors associated with aggressive end of life cancer care.
abstract: BACKGROUND
  Many patients with cancer experience aggressive care towards the end of life (EOL) despite evidence of an association with poor outcomes such as prolonged pain and overall dissatisfaction with care.
  
  
  OBJECTIVE
  To investigate socio-demographic, clinical and community health care service factors associated with aggressive EOL cancer care.
  
  
  METHODS
  An analysis of pooled data from two mortality follow-back surveys was performed. Aggressive EOL care was defined as greater than or equal to one of the following indicators occurring during the last 3 months of life: greater than or equal to two emergency department visits, ≥30 days in hospital and death in hospital.
  
  
  RESULTS
  Of the 681 included patients, 50.1% were men and mean age at death was 75 years. The majority of patients (59.3%, 95% confidence interval (CI) 55.6-63.0%) experienced at least one indicator of aggressive EOL care: 29.7% experienced greater than or equal to two ED visits, 17.1% spent ≥30 days in hospital and 37.9% died in hospital. Patients with prostate or haematological cancer were more likely to experience aggressive EOL care (adjusted odds ratio (AOR) 4.36, 95% CI 1.39-13.70, and 4.16, 95% CI 1.38-12.47, respectively, reference group lung cancer). Patients who received greater than five general practitioner (GP) home visits (AOR 0.37, 95% CI 0.17-0.82, reference group no GP visits) or had contact with district nursing (AOR 0.48, 95% CI 0.28-0.83, reference group no contact) or contact with community palliative care services (AOR 0.27, 95% CI 0.15-0.49, reference group no contact) were less likely to experience aggressive EOL care. No association was found between aggressive EOL care and patients' age, gender, marital, financial or health status.
  
  
  CONCLUSIONS
  Community health care services, in particular contact with community palliative care, are associated with a significant reduction in the odds of cancer patients receiving aggressive EOL care. Expansion of such services may help address the current capacity crises faced by many acute health care systems.
authors.affiliation: King's College London, Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK. lesley.henson@kcl.ac.uk.
authors.forename: Lesley A
authors.identifier: http://orcid.org/0000-0003-4799-7365
authors.initials: LA
authors.lastname: Henson
authors.affiliation: King's College London, Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: Gomes
authors.affiliation: King's College London, Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Koffman
authors.affiliation: King's College London, Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK.
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Daveson
authors.affiliation: King's College London, Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK.
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
authors.affiliation: King's College London, Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK.
authors.forename: Wei
authors.initials: W
authors.lastname: Gao
mesh_terms: D000368:Aged; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D013727:Terminal Care / Q000379:methods*
keywords: Community health services; Emergency service; Hospital; Hospital mortality; Neoplasms; Palliative care; Terminal care