title: Association of Palliative Care Consultation With Reducing Inpatient Chemotherapy Use in Elderly Patients With Cancer in Japan: Analysis Using a Nationwide Administrative Database.
abstract: BACKGROUND
  The administration of chemotherapy at the end of life is considered an aggressive life-prolonging treatment. The use of unnecessarily aggressive therapy in elderly patients at the end of life is an important health-care concern.
  
  
  OBJECTIVE
  To explore the impact of palliative care consultation (PCC) on chemotherapy use in geriatric oncology inpatients in Japan by analyzing data from a national database.
  
  
  METHODS
  We conducted a multicenter cohort study of patients aged ≥65 years, registered in the Japan National Administrative Healthcare Database, who died with advanced (stage ≥3) lung, stomach, colorectal, liver, or breast cancer while hospitalized between April 2010 and March 2013. The relationship between PCC and chemotherapy use in the last 2 weeks of life was analyzed using χ2and logistic regression analyses.
  
  
  RESULTS
  We included 26 012 patients in this analysis. The mean age was 75.74 ± 6.40 years, 68.1% were men, 81.8% had recurrent cancer, 29.5% had lung cancer, and 29.5% had stomach cancer. Of these, 3134 (12%) received PCC. Among individuals who received PCC, chemotherapy was administered to 46 patients (1.5%) and was not administered to 3088 patients (98.5%). Among those not receiving PCC, chemotherapy was administered to 909 patients (4%) and was not administered to the remaining 21 978 patients (96%; odds ratio [OR], 0.35; 95% confidence interval, 0.26-0.48). The OR of chemotherapy use was higher in men, young-old, and patients with primary cancer.
  
  
  CONCLUSIONS
  Palliative care consultation was associated with less chemotherapy use in elderly Japanese patients with cancer who died in the hospital setting.
authors.affiliation: 1 Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
authors.forename: Motoko
authors.initials: M
authors.lastname: Sano
authors.affiliation: 1 Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
mesh_terms: D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control* / Q000706:statistics & numerical data; D007564:Japan; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000628:therapy; D010166:Palliative Care / Q000379:methods / Q000592:standards; D012017:Referral and Consultation; D013727:Terminal Care / Q000379:methods / Q000706:statistics & numerical data
keywords: aggressive care; chemotherapy; end-of-life care; geriatric oncology; palliative care; quality measures