End-of-Life Care and Use of Hospital Resources in Radiotherapy-Treated Cancer Patients with Brain Metastases: A Single-Institution Retrospective Study
Purpose: The aim of this single-institution retrospective study of patients treated with radiotherapy for brain metastases (BM) was to evaluate the timing of the palliative care (PC) decision, the use of health care services, i.e., emergency department (ED) visits and hospitalizations, and the imple...
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Mary Ann Liebert
2024-10-01
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| Series: | Palliative Medicine Reports |
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| Online Access: | https://www.liebertpub.com/doi/10.1089/pmr.2024.0017 |
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| author | Nelli-Sofia Nåhls Anu Anttonen Eliisa Löyttyniemi Antti Jekunen Outi Akrén Tiina Saarto |
| author_facet | Nelli-Sofia Nåhls Anu Anttonen Eliisa Löyttyniemi Antti Jekunen Outi Akrén Tiina Saarto |
| author_sort | Nelli-Sofia Nåhls |
| collection | DOAJ |
| description | Purpose: The aim of this single-institution retrospective study of patients treated with radiotherapy for brain metastases (BM) was to evaluate the timing of the palliative care (PC) decision, the use of health care services, i.e., emergency department (ED) visits and hospitalizations, and the implementation of radiotherapy at the end of life (EOL). Methods: Data on all cancer patients with BM treated in Finland at the Vaasa Central Hospital Radiotherapy Department between March 2011 and November 2020 were retrospectively reviewed. The follow-up period lasted until November 2021. Altogether, 91 patients (54 men, mean age 67 years [range 23–91 years]) were analyzed. Data on timing of PC decision, visits to the PC outpatient unit, and ED and hospitalization periods were collected retrospectively from patients’ records. Results: The median overall survival from diagnosis of BM was 3.7 months (range 1–62 months) and, after radiotherapy, 2 months (0–61 months). Thirty-two percent of the patients received radiotherapy in the last month of life. During the last 30 days of life, 44 patients (48%) visited the ED and 38 (42%) were hospitalized. Patients with an early PC decision (>30 days before death) had fewer hospitalizations (22% vs. 53%; p = 0.005) and died less often during the hospitalization period (9% vs. 27%; p = 0.047) at EOL. No significant difference was found in ED visits (41% vs. 53%; p = 0.28). Conclusion: For a large proportion of patients with BM, the prognosis is very poor. It is important to identify these patients and abstain from radiotherapy at EOL to reducing inappropriate health care utilization. |
| format | Article |
| id | doaj-art-9d0f204f2dca4feba183482ba99ac770 |
| institution | OA Journals |
| issn | 2689-2820 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Mary Ann Liebert |
| record_format | Article |
| series | Palliative Medicine Reports |
| spelling | doaj-art-9d0f204f2dca4feba183482ba99ac7702025-08-20T02:30:49ZengMary Ann LiebertPalliative Medicine Reports2689-28202024-10-015131632310.1089/pmr.2024.0017End-of-Life Care and Use of Hospital Resources in Radiotherapy-Treated Cancer Patients with Brain Metastases: A Single-Institution Retrospective StudyNelli-Sofia Nåhls0Anu Anttonen1Eliisa Löyttyniemi2Antti Jekunen3Outi Akrén4Tiina Saarto5Department of Oncology, Vaasa Central Hospital, The Wellbeing Services County of Ostrobothnia, Vaasa, Finland.Department of Radiotherapy, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland.Department of Biostatistics, University of Turku and Turku University Hospital Turku, Turku Finland.Department of Oncology, Vaasa Central Hospital, The Wellbeing Services County of Ostrobothnia, Vaasa, Finland.Palliative Center, Tyks Hospital Services, Turku University Hospital, Turku, Finland.Department of Palliative Care, Comprehensive Cancer Center, Helsinki University Hospital, and Faculty of Medicine, Helsinki University, Helsinki, Finland.Purpose: The aim of this single-institution retrospective study of patients treated with radiotherapy for brain metastases (BM) was to evaluate the timing of the palliative care (PC) decision, the use of health care services, i.e., emergency department (ED) visits and hospitalizations, and the implementation of radiotherapy at the end of life (EOL). Methods: Data on all cancer patients with BM treated in Finland at the Vaasa Central Hospital Radiotherapy Department between March 2011 and November 2020 were retrospectively reviewed. The follow-up period lasted until November 2021. Altogether, 91 patients (54 men, mean age 67 years [range 23–91 years]) were analyzed. Data on timing of PC decision, visits to the PC outpatient unit, and ED and hospitalization periods were collected retrospectively from patients’ records. Results: The median overall survival from diagnosis of BM was 3.7 months (range 1–62 months) and, after radiotherapy, 2 months (0–61 months). Thirty-two percent of the patients received radiotherapy in the last month of life. During the last 30 days of life, 44 patients (48%) visited the ED and 38 (42%) were hospitalized. Patients with an early PC decision (>30 days before death) had fewer hospitalizations (22% vs. 53%; p = 0.005) and died less often during the hospitalization period (9% vs. 27%; p = 0.047) at EOL. No significant difference was found in ED visits (41% vs. 53%; p = 0.28). Conclusion: For a large proportion of patients with BM, the prognosis is very poor. It is important to identify these patients and abstain from radiotherapy at EOL to reducing inappropriate health care utilization.https://www.liebertpub.com/doi/10.1089/pmr.2024.0017brain metastasesemergency departmentend of lifehospital servicespalliative care decision |
| spellingShingle | Nelli-Sofia Nåhls Anu Anttonen Eliisa Löyttyniemi Antti Jekunen Outi Akrén Tiina Saarto End-of-Life Care and Use of Hospital Resources in Radiotherapy-Treated Cancer Patients with Brain Metastases: A Single-Institution Retrospective Study Palliative Medicine Reports brain metastases emergency department end of life hospital services palliative care decision |
| title | End-of-Life Care and Use of Hospital Resources in Radiotherapy-Treated Cancer Patients with Brain Metastases: A Single-Institution Retrospective Study |
| title_full | End-of-Life Care and Use of Hospital Resources in Radiotherapy-Treated Cancer Patients with Brain Metastases: A Single-Institution Retrospective Study |
| title_fullStr | End-of-Life Care and Use of Hospital Resources in Radiotherapy-Treated Cancer Patients with Brain Metastases: A Single-Institution Retrospective Study |
| title_full_unstemmed | End-of-Life Care and Use of Hospital Resources in Radiotherapy-Treated Cancer Patients with Brain Metastases: A Single-Institution Retrospective Study |
| title_short | End-of-Life Care and Use of Hospital Resources in Radiotherapy-Treated Cancer Patients with Brain Metastases: A Single-Institution Retrospective Study |
| title_sort | end of life care and use of hospital resources in radiotherapy treated cancer patients with brain metastases a single institution retrospective study |
| topic | brain metastases emergency department end of life hospital services palliative care decision |
| url | https://www.liebertpub.com/doi/10.1089/pmr.2024.0017 |
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