The Association of Palliative Care Decision on Secondary Health Care Utilization and Cancer Treatment at the End of Life Among Patients with Head and Neck Cancer: A Single-Center Retrospective Study

Abstract

<h3>Background:</h3><div>There is a lack of studies concerning the end of life (EOL) of patients with head and neck cancer (HNC).</div><h3>Objectives:</h3><div>To investigate whether the timing of palliative care decision (PCD), that is, decision to terminate life-prolonging anticancer treatments, is associated with reduced secondary health care utilization and medical procedures at the EOL among patients with head and neck cancer.</div><h3>Design and methods:</h3><div>A total of 108 patients with HNC treated at the Helsinki University Hospital Comprehensive Cancer Center were reviewed retrospectively. Three study groups were formed according to the timing of PCD: (1) the early PCD group (PCD >30 days prior to death), (2) the late PCD group (⩽30 days prior to death), and (3) the no PCD group.</div><h3>Results:</h3><div>PCD was made for 78 patients (72%), of which 57 (73%) were considered as early PCD and 21 (27%) as late. The median interval between PCD and death was 71 days (IQR 108). During the last month of life, a significantly smaller proportion of patients with an early PCD was hospitalized (19% vs 67%, OR = 0.12, CI [0.04-0.37], <em>P</em> < .001 and 19% vs 47%, OR = 0.27, CI [0.10-0.72], <em>P</em> = .007) and readmitted (5% vs 29%, OR = 0.14, CI [0.03-0.62], <em>P</em> = .004 and 5% vs 20%, OR = 0.22, CI [0.05-0.96], <em>P</em> = .032) in secondary health care compared with the patients with late or no PCD. Early PCD also associated with less ED visits (28% vs 52%, OR = 0.36, CI [0.126-0.997], <em>P</em> = .045) compared with the late PCD in the last month of life. Compared with the late PCD group, early PCD group was more likely to receive palliative radiotherapy (42% vs 14%, OR 4.36, 95% CI [1.15-16.51], <em>P</em> = .022).</div><h3>Conclusion:</h3><div>Early PCD associated with reduced utilization of secondary health care and emergency services at the EOL. The disease trajectories for patients with HNC should warrant more attention to the earlier timing of PCD.<br></div>