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- Title
High-Intensity Care in the End-of-Life Phase of Castration-Resistant Prostate Cancer Patients: Results from the Dutch CAPRI-Registry.
- Authors
Westgeest, Hans M.; Kuppen, Malou C.P.; van den Eertwegh, Fons A.J.M.; van Oort, Inge M.; Coenen, Juleon L.L.M.; van Moorselaar, Jeroen R.J.A.; Aben, Katja K.H.; Bergman, Andre M.; Huinink, Daan ten Bokkel; van den Bosch, Joan; Hendriks, Mathijs P.; Lampe, Menuhin I.; Lavalaye, Jules; Mehra, Niven; Smilde, Tineke J.; Somford, Rik D.M.; Tick, Lidwine; Weijl, Nir I.; van de Wouw, Yes A.J.; Gerritsen, Winald R.
- Abstract
Background: Intensive end-of-life care (i.e., the overuse of treatments and hospital resources in the last months of life), is undesirable since it has a minimal clinical benefit with a substantial financial burden. The aim was to investigate the care in the last three months of life (end-of-life [EOL]) in castration-resistant prostate cancer (CRPC). Methods: Castration-resistant prostate cancer registry (CAPRI) is an investigator-initiated, observational multicenter cohort study in 20 hospitals retrospectively including patients diagnosed with CRPC between 2010 and 2016. High-intensity care was defined as the initiation of life-prolonging drugs (LPDs) in the last month, continuation of LPD in last 14 days, >1 admission, admission duration ≥14 days, and/or intensive care admission in last three months of life. Descriptive and binary logistic regression analyses were performed. Results: High-intensity care was experienced by 41% of 2429 patients in the EOL period. Multivariable analysis showed that age (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.97–0.99), performance status (OR 0.57, 95% CI 0.33–0.97), time from CRPC to EOL (OR 0.98, 95% CI 0.97–0.98), referral to a medical oncologist (OR 1.99, 95% CI 1.55–2.55), prior LPD treatment (>1 line OR 1.72, 95% CI 1.31–2.28), and opioid use (OR 1.45, 95% CI 1.08–1.95) were significantly associated with high-intensity care. Conclusions: High-intensity care in EOL is not easily justifiable due to high economic cost and little effect on life span, but further research is awaited to give insight in the effect on patients' and their caregivers' quality of life.
- Subjects
NETHERLANDS; THERAPEUTIC use of narcotics; REPORTING of diseases; RESEARCH; TERMINAL care; LIFE support systems in critical care; SCIENTIFIC observation; ACQUISITION of data methodology; CONFIDENCE intervals; MULTIVARIATE analysis; FUNCTIONAL status; ANALGESICS; MEDICAL cooperation; RETROSPECTIVE studies; TREATMENT duration; CANCER patients; MEDICAL care use; MEDICAL records; DRUGS; DESCRIPTIVE statistics; BODY movement; MEDICAL referrals; LOGISTIC regression analysis; ODDS ratio; PROSTATE tumors; CANCER patient medical care; LONGITUDINAL method; ONCOLOGISTS
- Publication
Journal of Palliative Medicine, 2021, Vol 24, Issue 12, p1789
- ISSN
1096-6218
- Publication type
Article
- DOI
10.1089/jpm.2020.0800