Utilization of acute care services among women with metastatic breast cancer at the end of life

Slavish, Kathleen (2013) Utilization of acute care services among women with metastatic breast cancer at the end of life. Master's Thesis, University of Pittsburgh.

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Abstract

Background: Acute care utilization at the end of life among those with advanced cancer is increasing. Women with metastatic breast cancer (MBC) often remain in active treatment until close to death, often receiving futile chemotherapy and sometimes requiring emergency department (ED) visits that may result in admission to the hospital. Palliative care (PC) programs have aimed to reduce overuse by attempting to control symptoms and distress that may result in a visit to the ED or admission to the hospital. Purpose: Describe characteristics of women with MBC receiving care at an outpatient National Cancer Institute designated breast center, describe their acute care utilization during the last six months of life and examine those outcomes in view of specific demographic, disease and treatment factors. Methods and Analysis: Retrospective chart review according to protocolized abstraction of 100 MBC patients who died between 2010 and 2012 from one large urban practice. Records were reviewed for demographics, disease and treatment characteristics and acute care utilization of women with MBC during the last six months of life. Descriptive analysis and multiple regression was employed to test associations between age, race and income on each of the explored factors. Findings: 69% of all MBC patients visited the ED in the last 6 months of life and 26% died in the acute care setting. Of patients on active chemotherapy, nearly ½ of the ED visits were within 7 days of chemotherapy administration. 52% percent of patients received chemotherapy in the last 6 months of life for a total of 3.6 sequential lines during MBC treatment. There was no significant difference between PC (n=15) and Non-PC patients (n=85); suggesting that a “PRN” approach to PC may not have an impact on utilization of acute care resources. Public Health Relevance: Utilization of acute care services, including ED and chemotherapy, at the end of life is great among women with MBC. The model of PC delivery at this institution did not result in less utilization of acute care services at the end of life. Attention to the process of care, such as utilization of resources, is especially important in a population of patients with cancer nearing the end of life because of the potential for poor quality outcomes.

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Details

Item Type:	Other Thesis, Dissertation, or Long Paper (Master's Thesis)
Status:	Unpublished
Creators/Authors:	Creators Email Pitt Username ORCID Slavish, Kathleen
Contributors:	Contribution Contributors Name Email Pitt Username ORCID Committee Chair Donohue, Julie jdonohue@pitt.edu JDONOHUE UNSPECIFIED Committee Member Rosenzweig, Margaret mros@pitt.edu MROS UNSPECIFIED
Date:	16 April 2013
Date Type:	Publication
Access Restriction:	No restriction; Release the ETD for access worldwide immediately.
Publisher:	University of Pittsburgh
Institution:	University of Pittsburgh
Schools and Programs:	School of Public Health > Health Policy & Management
Degree:	MPH - Master of Public Health
Thesis Type:	Master's Thesis
Refereed:	Yes
Date Deposited:	06 May 2015 23:05
Last Modified:	27 Jul 2022 10:56
URI:	http://d-scholarship.pitt.edu/id/eprint/18618

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