Cancer Patients in US Nursing Homes: Quality of End of Life Care

Reviewer: Thomas Dilling, MD
The Abramson Cancer Center of the University of Pennsylvania
Ultima Vez Modificado: 18 de mayo del 2002

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Presenter: V.M.P. Johnson
Presenter's Affiliation: Brown University Medical School
Type of Session: Scientific

Background

  • As the American population ages, increasing numbers of Americans are receiving their end of life care in nursing homes.
  • Little information has been published regarding care in these nursing homes.

Materials and Methods

  • Secondary analysis was performed of the 1999 Minimum Data Set National Repository Data (includes information on 2.1 million individuals).
  • Specifically, the researchers analyzed advance care planning, pain management, use of hospice services, and the use of active treatment among nursing home residents with cancer.
  • These factors were analyzed by nursing home staff, which may introduce an ascertainment bias.
  • No information was available regarding the type of cancer or stage of disease in the patients.

Results

  • Within 60 days of April 1, 1999, 188,380 nursing home residents (9%) had a cancer diagnosis.
  • Median age was 81 years. 57% were female.
  • 23% had weight loss, 26% were receiving IV medication, and 24% required supplemental oxygen.
  • 46% had a DNR order, though DNR rates varied widely by state, with a range of 17%-75% (p value highly significant).
  • 47% of patients were frequently in persistent, severe pain.
  • State variations in pain varied from 40-60%.
  • Palliative chemotherapy or radiation were provided to very few of these patients (4% and 5%, respectively).
  • 14% received parenteral or tube feedings.
  • 11% were deemed "terminally ill," but less than one third received hospice services.

Author's Conclusions

  • One in ten nursing home patients has a diagnosis of cancer.
  • Nearly half of these experienced persistent, severe pain.
  • There was great state by state variation in utilization of DNR orders or pain control.

Clinical/Scientific Implications

  • Further research needs to be done to better ascertain the reasons for variability in pain control and end of life care in different geographic states in the US.
  • Overall, it appears that hospice and other palliative medical services are grossly underutilized in the nursing home population.
  • Future interventions will need to address these deficits.

Oncolink's ASCO Coverage made possible by an unrestricted Educational Grant from Bristol-Myers Squibb Oncology.

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Patients have better end-of-life quality, caregivers less psychiatric illness

Sep 15, 2010 - Terminal cancer patients who die in the hospital have higher distress levels and worse quality of life at the end of life than those who die at home with hospice care, and their bereaved caregivers are more likely to experience psychiatric illness, according to research published online Sept. 13 in the Journal of Clinical Oncology.



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