Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Division of Outcomes, Research and Quality, Department of Surgery, Penn State College of Medicine, Hershey, PA, USA.
J Geriatr Oncol. 2022 Nov;13(8):1111-1121. doi: 10.1016/j.jgo.2022.08.011. Epub 2022 Aug 27.
Aggressive end-of-life (EOL) care that is not aligned with the preferences of persons with cancer has negative impacts on their quality of life. Alzheimer's disease and related dementias (ADRD) could potentially complicate EOL care planning among persons with cancer. Little is known about the aggressive EOL care patterns among Medicare beneficiaries with both cancer and ADRD.
A matched retrospective cohort was created using the 2004 to 2016 Surveillance, Epidemiology, End Results-Medicare (SEER-Medicare) data differentiated by beneficiaries' ADRD status. Beneficiaries with breast, lung, colorectal, or prostate cancer who died between January 1, 2005 and December 31, 2016, were included. Six existing domains of aggressive EOL care and one overall indicator were derived. The major predictor was having ADRD comorbidity; other covariates included sex, marital status, census tract poverty indicator, race/ethnicity, metro status, geographic location, Charlson Comorbidity Index (CCI), survival time, cancer site, and histology stage. Multivariable logistic regression models were deployed to estimate the odds of receiving aggressive EOL care.
The study sample was 135,380 people after the one-to-one propensity score matching. The prevalence of aggressive EOL care utilization was slightly lower in beneficiaries with both cancer and ADRD when compared to beneficiaries with cancer only (54% vs. 58%, p < 0.0001). Beneficiaries with both cancer and ADRD were less likely to receive aggressive EOL care (AOR: 0.88, 95% CI: 0.86, 0.90) versus beneficiaries with cancer only. From the multivariable logistic regression model, certain beneficiaries' characteristics were associated with higher odds of receiving aggressive EOL care, such as: beneficiaries belonging to a racial/ethnic minority, a shorter survival time, and a higher CCI score.
The combined presence of ADRD and cancer was associated with lower odds of receiving aggressive EOL care compared to the presence of only cancer; however, the prevalence difference between the cohorts was not huge. Future studies could conduct in-depth evaluations of the ADRD's influence on the EOL care utilization.
不符合癌症患者偏好的积极临终关怀会对其生活质量产生负面影响。阿尔茨海默病和相关痴呆症（ADRD）可能会使癌症患者的临终关怀计划变得复杂。对于同时患有癌症和 ADRD 的医疗保险受益人的积极临终关怀模式知之甚少。
使用 2004 年至 2016 年监测、流行病学、最终结果-医疗保险（SEER-医疗保险）数据，根据受益人的 ADRD 状况创建了一个匹配的回顾性队列。纳入了 2005 年 1 月 1 日至 2016 年 12 月 31 日期间死亡的患有乳腺癌、肺癌、结直肠癌或前列腺癌的患者。得出了六个现有的积极临终关怀护理领域和一个整体指标。主要预测因素是患有 ADRD 合并症；其他协变量包括性别、婚姻状况、普查区贫困指标、种族/族裔、地铁状态、地理位置、Charlson 合并症指数（CCI）、生存时间、癌症部位和组织学分期。使用多变量逻辑回归模型估计接受积极临终关怀的几率。
在进行一对一倾向评分匹配后，研究样本为 135380 人。与仅患有癌症的患者相比，同时患有癌症和 ADRD 的患者接受积极临终关怀的比例略低（54%比 58%，p<0.0001）。同时患有癌症和 ADRD 的患者接受积极临终关怀的可能性较低（AOR：0.88，95%CI：0.86，0.90），而仅患有癌症的患者则较高。从多变量逻辑回归模型来看，某些受益人的特征与接受积极临终关怀的几率较高有关，例如：属于少数民族、生存时间较短和 CCI 评分较高的受益人群。
与仅患有癌症相比，同时患有 ADRD 和癌症与接受积极临终关怀的几率较低相关；然而，两个队列之间的患病率差异并不大。未来的研究可以深入评估 ADRD 对临终关怀利用的影响。
