Impact of Targeted Therapy on the Quality of End-of-Life Care for Patients With Non–Small-Cell Lung Cancer: A Population-Based Study in Taiwan
Journal
Journal of Pain and Symptom Management
Journal Volume
55
Journal Issue
3
Pages
798-807.e4
Date Issued
2018
Author(s)
Abstract
Context: Targeted therapies with epidermal growth factor receptor tyrosine kinase inhibitors have been widely used in the treatment of advanced non–small-cell lung cancer (NSCLC). However, little research has focused on the use of targeted therapies at the end of life (EOL). Objectives: This study investigated the determinants of receiving targeted therapy during the last month of life and how targeted therapies affect the quality of EOL care. Methods: We conducted a retrospective population-based study using a cancer registry and National Health Insurance claims data among 42,678 Taiwanese NSCLC decedents in 2005–2012. Propensity score matching and generalized linear mixed models were used to estimate associations. Results: We identified 3439 (21.3%) NSCLC patients who received targeted therapy within 30 days of death. Younger age, adenocarcinoma histology, postdiagnosis survival exceeding six months, and later year of death were associated with receiving targeted agents at EOL. The odds increased when patients were treated by pulmonologists or oncologists or in district hospitals or facilities with a higher case volume. Patients who were prescribed targeted therapy near death were significantly more likely to undergo aggressive EOL care (odds ratio = 2.35, 95% CI = 1.83–3.02) including multiple emergency department visits, hospitalization exceeding 14 days, admission to intensive care units, use of intubation and mechanical ventilation, cardiopulmonary resuscitation, and late hospice referrals. Conclusions: Targeted therapy at EOL should be considered a quality-of-care indicator. Guidance in the cessation of targeted therapy and the ongoing monitoring of practice initiatives are warranted. The decision-making processes associated with EOL care also require further investigation. ? 2017 American Academy of Hospice and Palliative Medicine
Subjects
aggressive care; end-of-life care; hospice; Non–small-cell lung cancer; targeted therapy
SDGs
Other Subjects
epidermal growth factor receptor kinase inhibitor; erlotinib; gefitinib; adult; aged; Article; artificial ventilation; cancer registry; cancer staging; cancer survival; case control study; emergency care; female; health care quality; histopathology; hospice care; hospitalization; human; human tissue; intensive care unit; intubation; large cell carcinoma; lung adenocarcinoma; major clinical study; male; middle aged; molecularly targeted therapy; non small cell lung cancer; patient referral; propensity score; pulmonologist; resuscitation; retrospective study; squamous cell lung carcinoma; Taiwan; terminal care; very elderly; lung tumor; mortality; non small cell lung cancer; procedures; statistical model; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Case-Control Studies; Female; Humans; Linear Models; Lung Neoplasms; Male; Middle Aged; Propensity Score; Retrospective Studies; Taiwan; Terminal Care
Type
journal article