The Association Between Depression, Intensity of End-of-life Care and Advance Care Planning Among Patients with Cancer (RP300)

Abstract

•Describe patterns of high-intensity end-of-life healthcare utilization by presence of absence of depression among patients with cancer.•Recognize opportunities to address depression to ensure goal-concordant end-of-life care to patients with cancer. The impact of depression on cancer diagnosis timing and anti-cancer therapy receipt has been explored, but limited data exist on the relationship between depression, end-of-life (EOL) healthcare utilization, and advance care planning (ACP) documentation. We examined high-intensity EOL healthcare and ACP documentation (e.g., living wills, durable power of attorney for healthcare, physician orders for life-sustaining treatment) by patients with cancer, comparing those with and without depression, to examine how depression impacts EOL healthcare and ACP documentation. We included patients with poor-prognosis cancer at UW Medicine who died between 2010 and 2017. In addition to depression, we identified chronic comorbidities (CCs) in the 24 months preceding death using ICD9-10 codes, including: chronic pulmonary disease, coronary artery disease, heart failure, severe chronic liver disease, chronic renal disease, dementia, and diabetes with end-organ damage. Outcomes included ACP documentation, in-hospital death, emergency department (ED) visit, hospitalization, or ICU admission in the month before death. We performed logistic regression controlling for confounders defined a priori (age, race, sex, marital status, insurance, education, total CCs). Of 15,092 patients with cancer, 3,585 (34%) had a depression diagnosis. Compared to patients with cancer without depression (n=11,507, 76%), depression was significantly associated with presence of ACP documents 31-180 days before death (OR 1.72, 95% CI 1.58-1.88), and increased healthcare utilization in the last 30 days including: ED visit (OR 1.78, 95% CI 1.43-2.21), hospitalization (OR 1.39, 95% CI 1.27-1.52), and ICU admission (OR 1.15, 95% CI 1.02-1.28). The groups did not differ on in-hospital death or ACP in the last 30 days. Despite higher odds of ACP documents in the months preceding death, patients with cancer and depression experienced higher intensity of care in the last month.