Introduction

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.

Materials and methods

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.

Results

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.

Discussion

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.

中文翻译：

---

同时患有癌症和阿尔茨海默病及相关痴呆症的老年患者与仅患有癌症的患者临终关怀模式的比较

介绍

不符合癌症患者偏好的积极临终 (EOL) 护理会对他们的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 EOL 护理计划复杂化。对于同时患有癌症和 ADRD 的 Medicare 受益人中积极的 EOL 护理模式，我们知之甚少。

材料和方法

使用 2004 年至 2016 年监测、流行病学、最终结果-医疗保险 (SEER-Medicare) 数据创建了一个匹配的回顾性队列，这些数据根据受益人的 ADRD 状态进行区分。包括在 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受益人。得出了六个现有的积极 EOL 护理领域和一个总体指标。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、人口普查贫困指标、种族/族裔、都会区状况、地理位置、查尔森合并症指数 (CCI)、生存时间、癌症部位和组织学分期。部署了多变量逻辑回归模型来估计接受积极 EOL 护理的几率。

结果

一对一倾向得分匹配后的研究样本为 135,380 人。与仅患有癌症的受益人相比，同时患有癌症和 ADRD 的受益人积极使用 EOL 护理的比例略低（54% 对 58%，p  < 0.0001）。与仅患有癌症的受益人相比，同时患有癌症和 ADRD 的受益人不太可能接受积极的 EOL 护理（AOR：0.88，95% CI：0.86，0.90）。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的 EOL 护理的几率更高有关，例如：属于少数种族/族裔的受益人、更短的生存时间和更高的 CCI 评分。

讨论

与仅存在癌症相比，同时存在 ADRD 和癌症与接受积极的 EOL 护理的几率较低相关；然而，队列之间的患病率差异并不大。未来的研究可以对 ADRD 对 EOL 护理利用的影响进行深入评估。