Background

Results of previous studies demonstrated that high-intensity end-of-life (EOL) care improves neither cancer patients’ survival nor quality of life. Our objective was to assess the incidence of and factors associated with aggressiveness of care during the last 30 days of life (DOL) of lung cancer (LC) patients and the impacts of aggressiveness of care in EOL-care costs.

Patients and Methods

Using French national hospital database, all patients with LC who died between January 1, 2010, and December 31, 2011, or between January 1, 2015, and January 31, 2016, were included. EOL-care aggressiveness was assessed using the following criteria: chemotherapy administered within the last 14 DOL; more than one hospitalization within the last 30 DOL; admission to the intensive care unit within the last 30 DOL; and palliative care initiated < 3 days before death. Expenditures were limited to direct costs, from a health care payer’s perspective.

Results

Among 79,746 adult LC patients identified; 57% had at least one indicator of EOL-care aggressiveness (49% repeated hospitalizations, 12% intensive care unit admissions, 9% chemotherapy, 5% palliative care). It increased significantly between the 2 periods (56% vs. 58%, P < .001). Young age, male sex, shorter time since diagnosis, comorbidities, no malnutrition, type of care facility other than general hospital, social deprivation, and low-density population were independently associated with having one or more indicator of aggressive EOL care. The mean EOL cost was €8152 ± 5117 per patient, but the cost was significantly higher for patients with at least one EOL-care aggressiveness criterion (€9480 vs. €6376, P < .001).

Conclusion

In France, a majority of LC patients had at least one criterion of aggressive EOL care that had a major economic impact on the health care system.

中文翻译：

---

与肺癌患者临终关怀积极性和相关护理成本相关的因素

背景

先前的研究结果表明，高强度的临终关怀 (EOL) 既不能提高癌症患者的生存率，也不能提高生活质量。我们的目标是评估肺癌 (LC) 患者生命的最后 30 天 (DOL) 期间积极护理的发生率和相关因素，以及积极护理对 EOL 护理成本的影响。

患者和方法

使用法国国家医院数据库，纳入2010年1月1日至2011年12月31日或2015年1月1日至2016年1月31日期间死亡的所有LC患者。使用以下标准评估 EOL 护理的积极性：在最后 14 个 DOL 内实施的化疗；在过去 30 个 DOL 内住院超过 1 次；在过去的 30 DOL 内入住重症监护室；并且在死亡前 < 3 天开始姑息治疗。从医疗保健支付者的角度来看，支出仅限于直接成本。

结果

在确定的 79,746 名成人 LC 患者中；57% 至少有一项 EOL 护理积极性指标（49% 重复住院，12% 重症监护室入院，9% 化疗，5% 姑息治疗）。它在两个时期之间显着增加（56% 对 58%，P  < .001）。年轻、男性、自诊断时间较短、合并症、无营养不良、综合医院以外的护理设施类型、社会剥夺和低密度人口与一项或多项积极的 EOL 护理指标独立相关。每名患者的平均 EOL 成本为 8152 ± 5117 欧元，但至少具有一项 EOL 护理积极性标准的患者的成本显着更高（9480 欧元对比 6376 欧元，P  < .001）。

结论

在法国，大多数 LC 患者至少有一项对医疗保健系统具有重大经济影响的积极 EOL 护理标准。