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Determinants for Aggressive End-of-Life Care for Oral Cancer Patients: A Population-Based Study in an Asian Country

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...

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Autores principales: Chang, Ting-Shou, Su, Yu-Chieh, Lee, Ching-Chih
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602967/
https://www.ncbi.nlm.nih.gov/pubmed/25634186
http://dx.doi.org/10.1097/MD.0000000000000460
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author Chang, Ting-Shou
Su, Yu-Chieh
Lee, Ching-Chih
author_facet Chang, Ting-Shou
Su, Yu-Chieh
Lee, Ching-Chih
author_sort Chang, Ting-Shou
collection PubMed
description 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.
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spelling pubmed-46029672015-10-27 Determinants for Aggressive End-of-Life Care for Oral Cancer Patients: A Population-Based Study in an Asian Country Chang, Ting-Shou Su, Yu-Chieh Lee, Ching-Chih Medicine (Baltimore) 5700 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. Wolters Kluwer Health 2015-01-30 /pmc/articles/PMC4602967/ /pubmed/25634186 http://dx.doi.org/10.1097/MD.0000000000000460 Text en Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0
spellingShingle 5700
Chang, Ting-Shou
Su, Yu-Chieh
Lee, Ching-Chih
Determinants for Aggressive End-of-Life Care for Oral Cancer Patients: A Population-Based Study in an Asian Country
title Determinants for Aggressive End-of-Life Care for Oral Cancer Patients: A Population-Based Study in an Asian Country
title_full Determinants for Aggressive End-of-Life Care for Oral Cancer Patients: A Population-Based Study in an Asian Country
title_fullStr Determinants for Aggressive End-of-Life Care for Oral Cancer Patients: A Population-Based Study in an Asian Country
title_full_unstemmed Determinants for Aggressive End-of-Life Care for Oral Cancer Patients: A Population-Based Study in an Asian Country
title_short Determinants for Aggressive End-of-Life Care for Oral Cancer Patients: A Population-Based Study in an Asian Country
title_sort determinants for aggressive end-of-life care for oral cancer patients: a population-based study in an asian country
topic 5700
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602967/
https://www.ncbi.nlm.nih.gov/pubmed/25634186
http://dx.doi.org/10.1097/MD.0000000000000460
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