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Cecile Blein



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    MA14 - Survivorship, Socioeconomic and End-of-Life Considerations (ID 915)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Treatment in the Real World - Support, Survivorship, Systems Research
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 10:30 - 12:00, Room 205 BD
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      MA14.03 - Aggressiveness of Cares on the Month Before Death of Patients with Lung Cancer: A French National Database Survey (ID 12005)

      10:40 - 10:45  |  Author(s): Cecile Blein

      • Abstract
      • Presentation
      • Slides

      Background

      Prior studies have demonstrated that high-intensity end of life (EOL) cares improves neither survival nor quality of life for cancer patients. The National Quality Forum endorses markers of poor EOL care for cancer patients but there is little data’s concerning lung cancer patients (1). The aim of this study was to assess, the quality of management during the last month of life of lung cancer patients managed in France and factors associated EOL aggressiveness.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Using a French hospital discharge database (PMSI, Programme de Médicalisation des Systèmes d’Information), all patients with lung cancer who died between January 1, 2010 and December 31, 2011 (cohort 1) and between January 1, 2015 and December 31, 2016 (cohort 2) were identified through the International Classification of Diseases 10th version (ICD-10). Aggressiveness of EOL cares was assessed by the following criteria’s 1) chemotherapy administrated within last 14 days of life (DOL); 2) > 1 hospitalization within 30 DOL; 3) ICU admission within 30 DOL; and 4) Palliative care < 3 days before death. Multivariate analysis was performed to identify individual determinants EOL aggressiveness.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 90,827 incident adult patients were identified (cohort 1: 43,862, cohort 2: 46,965): men: 74%, median age: 67 years], metastatic at diagnosis: 70%; 57% have at least one marker of aggressiveness of EOL cares (repeated hospitalizations: 49%, ICU admissions: 12%, chemotherapy within 14 DOL: 9%, palliative care < 3 days before death: 5%). A significant increase was observed between 2010/2011 and 2015/2016 for repeated hospitalizations (48% vs 51%, p<.001) and ICU admissions (11% vs 13%, p<.001); the two other markers have remained stable. In multivariate analysis of cohort 2, the risk of aggressiveness of care in EOL was increased by the presence of COPD (OR: 1.08, 95%CI: 1.02-1.14) and a management in an anti-cancer center (OR: 2.32,95%CI 2.05-2.61) while advanced age (OR: 0.51, 95%CI 0.47-0.55), female sex (OR: 0.86 95%CI: 0.82-0.90), malnutrition (OR: 0.72, 95%CI:0.68-0.76) were protective factors for EOL aggressiveness of cares.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Despite growing focus on providing appropriate EOL cares, in this analysis 57% of deceased lung cancer patients in France received aggressive EOL cares. Research must be undertaken to better identify patients at risk of aggressive EOL cares and to improve the quality of cares of last days of life these patients.

      1.McNiff KK, . Measuring supportive care in medical oncology practice: lessons learned from the quality oncology practice initiative. JCO 2008;

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P2.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 964)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.15-04 - Costs of Cares on the Month Before Death of Patients with Lung Cancer: A French National Database Survey (ID 12006)

      16:45 - 18:00  |  Author(s): Cecile Blein

      • Abstract
      • Slides

      Background

      There is a few data’s on the burden of the last month of life of patient with lung cancer and on impact of end of life (EOL) aggressiveness of cares. The aim of this study was to assess the costs of the month before death in patients with lung cancer and the impact of aggressiveness of cares during this period.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Using a French hospital discharge database (PMSI, Programme de Médicalisation des Systèmes d’Information), all adult patients with lung cancer who death between January 1, 2010 and December 31, 2011 (cohort 1) and between January 1, 2015 and December 31, 2016 (cohort 2) were identified through the International Classification of Diseases 10th version (ICD-10). Aggressiveness of EOL cares was assessed by the following criteria’s 1) chemotherapy administrated within last 14 days of life (DOL); 2) > 1 hospitalizations within 30 DOL; 3) ICU admission within 30 DOL; and 4) palliative care < 3 days before death.Direct hospital costs were assessed from the French public health insurer perspective based on DRG tariffs. Costs were expressed in 2017 Euros.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 90,827 i patients were identified: men: 74%, median age: 67 years [59-77], metastatic at diagnosis: 70%;57% have at least one marker of aggressiveness of EOL cares (repeated hospitalization: 49%, ICU admissions: 12%, chemotherapy within 14 DOL: 9%, and palliative care < 3 days before death: 5%). The mean cost of last month of EOL was € 8,152 ± 5,117 (346 - 91,537) per patient, significantly more important in patients with at least one aggressiveness marker of EOL cares (€ 9,480±5,946 vs € 6,376±2,898, p <0.001). These over-costs were explained in large part by hospitalizations and intensives cares costs (€ 8,080 ± 4,296 vs € 6,228 ±2,752 and € 1,063 ± 2,948 vs € 92 ± 546). The cost of expensive drugs (€ 285 ± 888 vs € 39 ± 330), radiotherapy (€ 14 ± 138 vs € 6 ± 84) and medical devices (€ 38 ± 352 vs € 11 ± 137) does not impact the extra costs of patients with markers of aggressiveness of cares.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The EOL economic burden is major for the healthcare system, with extra costs of more than € 3,000 per patient in case of EOL aggressiveness markers. Organizing a precocious palliative care system may improve the quality of cares of EOL and reduce the financial costs of the last days of life of lung cancers patients.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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