Intensity of End-of-life Care and Advance Care Planning Among Patients with Cancer and Multiple Chronic Conditions (S720)

Abstract

•Describe patterns of high-intensity end-of-life healthcare utilization by type of co-occurring multiple chronic conditions among patients with cancer.•Recognize opportunities for collaboration across specialties to provide goal-concordant end-of-life care to patients with cancer and multiple chronic conditions. While previous studies of patients with multiple chronic conditions (MCCs) have largely focused on those without cancer, most patients with cancer have MCCs. We examined frequency of high-intensity end-of-life (EOL) healthcare and advance care planning (ACP) by patients with cancer and different MCCs to better understand how MCCs impact EOL healthcare use in this population. We included patients with poor prognosis cancer in the UW Medicine system who died 2010-2017. We defined MCCs as chronic illnesses identified in the 24 months preceding death, including: chronic pulmonary disease, coronary artery disease (CAD), heart failure (HF), severe chronic liver disease, chronic renal disease, dementia, diabetes with end organ damage, or peripheral vascular disease. Outcomes included ACP documentation, death in hospital, and inpatient or ICU admission in the month before death. We performed logistic regression for outcomes controlling for confounders defined a priori (age, race, sex, marital status, insurance, education, functional limitation, total number of MCCs). Of 10,596 patients with cancer and 1+ MCC, common MCCs were: pulmonary (25%, n=2608), CAD (23%, n=2469), renal (18%, n=1916). As compared with patients with cancer and other MCCs, patients with cancer and HF had highest odds of dying in hospital (OR 1.75, 95% CI 1.52-2.02), being hospitalized (OR 1.57, 95% CI 1.35-1.83) or having an ICU admission (OR 2.19, 95% CI 1.83-2.62) while patients with cancer and liver disease had significantly higher odds of ACP 31-180 days before death (OR 1.24, 95% CI 1.08-1.43); we found no significant association for other MCCs. EOL healthcare use and ACP varied by MCC among patients with cancer; consideration of type, not just number, of MCCs is important when examining EOL healthcare use.