In a study to be presented by Khaki et al at the 2019 ASCO Quality Care Symposium, researchers found more aggressive end-of-life measures—including use of chemotherapy and admissions to the intensive care unit (ICU)—were employed in the last 30 days of life in Western Washington state vs Alberta, Canada (Abstract 89).
Methods
Researchers hypothesized that, despite similar populations and cancer delivery systems, end-of-life care may be more intense in the United States’ multipayer health-care system vs the Canadian single-payer system. Adult patients with stage II to IV solid cancers who died between 2014 and 2016 were identified from regional population-based cancer registries, including the Washington State Cancer Registry; the Western Washington Cancer Surveillance System (linked to enrollment files and claims from four regional insurers); the Canadian National Ambulatory Care Reporting System; Discharge Abstracts Database; and chemotherapy records from Alberta Health Services. The proportions of patients who received chemotherapy, were admitted to the ICU, or had more than one visit to the emergency department in the last 30 days of life in Washington and Alberta were determined and compared.
Approximately 11,200 patients in Alberta and 7,900 patients in Washington met the study inclusion criteria. The most common cancer types represented included lung (31% of Canadian patients vs 35% of American patients, respectively), colorectal (17% vs 9%), breast (10% vs 6%) and prostate (11% vs 4%).
KEY POINTS
- 12.4% of patients in Washington vs 12.1% in Alberta had multiple recorded emergency department visits in the last 30 days of life.
- Chemotherapy use in the last 14 and 30 days of life was greater in the United States vs Canada (6.3% and 13.4% vs 2.7% and 6.6%, respectively).
- ICU admissions occurred in 19.9% of American patients vs 3.9% of Canadian patients.
Findings
A similar proportion of patients in both the United States and Canada had multiple recorded emergency department visits in the last 30 days of life (12.4% in Washington vs 12.1% in Alberta). Chemotherapy use in the last 14 and 30 days of life was greater in the United States vs Canada (6.3% and 13.4% vs 2.7% and 6.6%, respectively). ICU admissions in the last 30 days of life were more common in the United States vs Canada (19.9% vs 3.9%).
The authors concluded, “Chemotherapy use and ICU admissions in the last 30 days of life were more common in Washington than Alberta. The lower rate of ICU admissions in Alberta may be due to a provincial effort to prioritize goals of care discussions. Future studies to characterize and compare drivers of inappropriately aggressive end-of-life care may help improve cancer care for patients in the United States and Alberta.”
Disclosure: For full disclosures of the study authors, visit coi.asco.org.
