End-of-life intensity for adolescents and young adults with cancer: A californian population-based study that shows disparities

Emily E. Johnston, Elysia Alvarez, Olga Saynina, Lee Sanders, Smita Bhatia, Lisa J. Chamberlain

Research output: Contribution to journalArticle

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Abstract

Purpose Cancer is the leading cause of nonaccidental death among adolescents and young adults (AYAs). High-intensity end-of-life care is expensive and may not be consistent with patient goals. However, the intensity of end-of-life care forAYAdecedents with cancer-especially the effect of care received at specialty versus nonspecialty centers-remains understudied. Methods We conducted a retrospective, population-based analysis with the California administrative discharge database that is linked to death certificates. The cohort included Californians age 15 to 39 years who died between 2000 and 2011 with cancer. Intense end-of-life interventions included readmission, admission to an intensive care unit, intubation in the last month of life, and in-hospital death. Specialty centers were defined as Children's Oncology Group centers and National Cancer Institute-designated comprehensive cancer centers. Results Of the 12, 938 AYA cancer decedents, 59% received at least one intense end-of-life care intervention, and30%received twoor more. Patients treated at nonspecialty centers were more likely than those at specialty-care centers to receive two or more intense interventions (odds ratio [OR], 1.46; 95% CI, 1.32 to 1.62). Sociodemographic and clinical factors associated with twoormoreintense interventions included minority race/ethnicity (Black [OR, 1.35, 95% CI, 1.17 to 1.56]; Hispanic [OR, 1.24; 95% CI, 1.12 to 1.36]; non-Hispanic white: reference), younger age (15 to 21 years [OR, 1.36; 95% CI, 1.19 to 1.56; 22 to 29 years [OR, 1.26; 95% CI, 1.14 to 1.39]; 30 years: reference), and hematologic malignancies (OR, 1.53; 95% CI, 1.41 to 1.66; solid tumors: reference). Conclusion Thirty percent of AYA cancer decedents received two or more high-intensity end-of-life interventions. In addition to sociodemographic and clinical characteristics, hospitalization in a nonspecialty center was associated with high-intensity end-of-life care. Additional research is needed to determine if these disparities are consistent with patient preference.

Original languageEnglish (US)
Pages (from-to)e770-e781
JournalJournal of Oncology Practice
Volume13
Issue number9
DOIs
StatePublished - Sep 1 2017
Externally publishedYes

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Young Adult
Terminal Care
Odds Ratio
Population
Neoplasms
Death Certificates
National Cancer Institute (U.S.)
Patient Preference
Hematologic Neoplasms
Hispanic Americans
Intubation
Intensive Care Units
Cause of Death
Hospitalization
Databases
Research

ASJC Scopus subject areas

  • Oncology
  • Oncology(nursing)
  • Health Policy

Cite this

End-of-life intensity for adolescents and young adults with cancer : A californian population-based study that shows disparities. / Johnston, Emily E.; Alvarez, Elysia; Saynina, Olga; Sanders, Lee; Bhatia, Smita; Chamberlain, Lisa J.

In: Journal of Oncology Practice, Vol. 13, No. 9, 01.09.2017, p. e770-e781.

Research output: Contribution to journalArticle

Johnston, Emily E. ; Alvarez, Elysia ; Saynina, Olga ; Sanders, Lee ; Bhatia, Smita ; Chamberlain, Lisa J. / End-of-life intensity for adolescents and young adults with cancer : A californian population-based study that shows disparities. In: Journal of Oncology Practice. 2017 ; Vol. 13, No. 9. pp. e770-e781.
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title = "End-of-life intensity for adolescents and young adults with cancer: A californian population-based study that shows disparities",
abstract = "Purpose Cancer is the leading cause of nonaccidental death among adolescents and young adults (AYAs). High-intensity end-of-life care is expensive and may not be consistent with patient goals. However, the intensity of end-of-life care forAYAdecedents with cancer-especially the effect of care received at specialty versus nonspecialty centers-remains understudied. Methods We conducted a retrospective, population-based analysis with the California administrative discharge database that is linked to death certificates. The cohort included Californians age 15 to 39 years who died between 2000 and 2011 with cancer. Intense end-of-life interventions included readmission, admission to an intensive care unit, intubation in the last month of life, and in-hospital death. Specialty centers were defined as Children's Oncology Group centers and National Cancer Institute-designated comprehensive cancer centers. Results Of the 12, 938 AYA cancer decedents, 59{\%} received at least one intense end-of-life care intervention, and30{\%}received twoor more. Patients treated at nonspecialty centers were more likely than those at specialty-care centers to receive two or more intense interventions (odds ratio [OR], 1.46; 95{\%} CI, 1.32 to 1.62). Sociodemographic and clinical factors associated with twoormoreintense interventions included minority race/ethnicity (Black [OR, 1.35, 95{\%} CI, 1.17 to 1.56]; Hispanic [OR, 1.24; 95{\%} CI, 1.12 to 1.36]; non-Hispanic white: reference), younger age (15 to 21 years [OR, 1.36; 95{\%} CI, 1.19 to 1.56; 22 to 29 years [OR, 1.26; 95{\%} CI, 1.14 to 1.39]; 30 years: reference), and hematologic malignancies (OR, 1.53; 95{\%} CI, 1.41 to 1.66; solid tumors: reference). Conclusion Thirty percent of AYA cancer decedents received two or more high-intensity end-of-life interventions. In addition to sociodemographic and clinical characteristics, hospitalization in a nonspecialty center was associated with high-intensity end-of-life care. Additional research is needed to determine if these disparities are consistent with patient preference.",
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T1 - End-of-life intensity for adolescents and young adults with cancer

T2 - A californian population-based study that shows disparities

AU - Johnston, Emily E.

AU - Alvarez, Elysia

AU - Saynina, Olga

AU - Sanders, Lee

AU - Bhatia, Smita

AU - Chamberlain, Lisa J.

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Purpose Cancer is the leading cause of nonaccidental death among adolescents and young adults (AYAs). High-intensity end-of-life care is expensive and may not be consistent with patient goals. However, the intensity of end-of-life care forAYAdecedents with cancer-especially the effect of care received at specialty versus nonspecialty centers-remains understudied. Methods We conducted a retrospective, population-based analysis with the California administrative discharge database that is linked to death certificates. The cohort included Californians age 15 to 39 years who died between 2000 and 2011 with cancer. Intense end-of-life interventions included readmission, admission to an intensive care unit, intubation in the last month of life, and in-hospital death. Specialty centers were defined as Children's Oncology Group centers and National Cancer Institute-designated comprehensive cancer centers. Results Of the 12, 938 AYA cancer decedents, 59% received at least one intense end-of-life care intervention, and30%received twoor more. Patients treated at nonspecialty centers were more likely than those at specialty-care centers to receive two or more intense interventions (odds ratio [OR], 1.46; 95% CI, 1.32 to 1.62). Sociodemographic and clinical factors associated with twoormoreintense interventions included minority race/ethnicity (Black [OR, 1.35, 95% CI, 1.17 to 1.56]; Hispanic [OR, 1.24; 95% CI, 1.12 to 1.36]; non-Hispanic white: reference), younger age (15 to 21 years [OR, 1.36; 95% CI, 1.19 to 1.56; 22 to 29 years [OR, 1.26; 95% CI, 1.14 to 1.39]; 30 years: reference), and hematologic malignancies (OR, 1.53; 95% CI, 1.41 to 1.66; solid tumors: reference). Conclusion Thirty percent of AYA cancer decedents received two or more high-intensity end-of-life interventions. In addition to sociodemographic and clinical characteristics, hospitalization in a nonspecialty center was associated with high-intensity end-of-life care. Additional research is needed to determine if these disparities are consistent with patient preference.

AB - Purpose Cancer is the leading cause of nonaccidental death among adolescents and young adults (AYAs). High-intensity end-of-life care is expensive and may not be consistent with patient goals. However, the intensity of end-of-life care forAYAdecedents with cancer-especially the effect of care received at specialty versus nonspecialty centers-remains understudied. Methods We conducted a retrospective, population-based analysis with the California administrative discharge database that is linked to death certificates. The cohort included Californians age 15 to 39 years who died between 2000 and 2011 with cancer. Intense end-of-life interventions included readmission, admission to an intensive care unit, intubation in the last month of life, and in-hospital death. Specialty centers were defined as Children's Oncology Group centers and National Cancer Institute-designated comprehensive cancer centers. Results Of the 12, 938 AYA cancer decedents, 59% received at least one intense end-of-life care intervention, and30%received twoor more. Patients treated at nonspecialty centers were more likely than those at specialty-care centers to receive two or more intense interventions (odds ratio [OR], 1.46; 95% CI, 1.32 to 1.62). Sociodemographic and clinical factors associated with twoormoreintense interventions included minority race/ethnicity (Black [OR, 1.35, 95% CI, 1.17 to 1.56]; Hispanic [OR, 1.24; 95% CI, 1.12 to 1.36]; non-Hispanic white: reference), younger age (15 to 21 years [OR, 1.36; 95% CI, 1.19 to 1.56; 22 to 29 years [OR, 1.26; 95% CI, 1.14 to 1.39]; 30 years: reference), and hematologic malignancies (OR, 1.53; 95% CI, 1.41 to 1.66; solid tumors: reference). Conclusion Thirty percent of AYA cancer decedents received two or more high-intensity end-of-life interventions. In addition to sociodemographic and clinical characteristics, hospitalization in a nonspecialty center was associated with high-intensity end-of-life care. Additional research is needed to determine if these disparities are consistent with patient preference.

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