What are determinants of utilisation of pharmaceutical anticancer treatment during the last year of life in Norway? A retrospective registry study

OBJECTIVES: The objective of this study was to investigate the use of, and predictors for, pharmaceutical anticancer treatment (PACT) towards the end of a patient’s life in a country with a public healthcare system. DESIGN: Retrospective registry study. SETTING: Secondary care in Norway. PARTICIPANTS: All Norwegian patients with cancer (International Classification of Diseases tenth revision (ICD-10) codes C00–99, D00–09, D37–48) in contact with a somatic hospital in Norway between 2009 and 2017 (N=420 655). Analyses were performed on a subsample of decedents with follow-back time of more than 1 year (2013–2017, N=52 496). INTERVENTIONS: N/A. PRIMARY AND SECONDARY OUTCOME MEASURES: Proportion of patients receiving PACT during the last year and month of life. We calculated CIs with block bootstrapping, while predictors of PACT were estimated with logistic regression. RESULTS: 24.0% (95% CI 23.4% to 24.6%) of the patients received PACT during the last year of life and 3.2% (95% CI 3.0% to 3.5%) during their final month. The proportion during the last month was highest for multiple myeloma (12.7%) and breast cancer (6.5%) and lowest for urinary tract (1.1%) and prostate and kidney cancer (1.4%). Patients living in northern (OR 0.80, 95% CI 0.68 to 0.94) and western (OR 0.85, 95% CI 0.75 to 0.96) Norway had lower odds of PACT during the last month, while patients with myeloma (OR 3.0, 95% CI 2.5 to 3.7) and breast (OR 1.4, 95% CI 1.1 to 1.6) had higher odds. Kidney cancer (OR 0.25, 95% CI 0.2. to 0.4), urinary tract (OR 0.38, 95% CI 0.3 to 0.5) and prostate cancer (OR 0.4, 95% CI 0.3 to 0.5) were associated with lower probability of receiving PACT within the last month. CONCLUSIONS: The proportion of patients receiving PACT in Norway is lower than in several other industrialised countries. Age, type of cancer and area of living are significant determinants of variation in PACT.