{
  "abstract": "Objectives To describe variations in the receipt of potentially inappropriate interventions in the last 100 days of life of patients with cancer according to patient characteristics and cancer site.Methods We conducted a population-based retrospective cohort study of cancer decedents in Ontario, Canada who died between 1 January 2013 and 31 December 2018. Potentially inappropriate interventions, including chemotherapy, major surgery, intensive care unit admission, cardiopulmonary resuscitation, defibrillation, dialysis, percutaneous coronary intervention, mechanical ventilation, feeding tube placement, blood transfusion and bronchoscopy, were captured via hospital discharge records. We used Poisson regression to examine associations between interventions and decedent age, sex, rurality, income and cancer site.Results Among 151 618 decedents, 81.3% received at least one intervention, and 21.4% received 3+ different interventions. Older patients (age 95–105 years vs 19–44 years, rate ratio (RR) 0.36, 95% CI 0.34 to 0.38) and women (RR 0.94, 95% CI 0.93 to 0.94) had lower intervention rates. Rural patients (RR 1.09, 95% CI 1.08 to 1.10), individuals in the highest area-level income quintile (vs lowest income quintile RR 1.02, 95% CI 1.01 to 1.04), and patients with pancreatic cancer (vs colorectal cancer RR 1.10, 95% CI 1.07 to 1.12) had higher intervention rates.Conclusions Potentially inappropriate interventions were common in the last 100 days of life of cancer decedents. Variations in interventions may reflect differences in prognostic awareness, healthcare access, and care preferences and quality. Earlier identification of patients’ palliative care needs and involvement of palliative care specialists may help reduce the use of these interventions at the end of life.",
  "authors": [
    {
      "affiliations": [
        "Ottawa Hospital Research Institute, Ottawa, Ontario, Canada",
        "Bruyère Research Institute, Ottawa, Ontario, Canada"
      ],
      "name": "Colleen Webber"
    },
    {
      "affiliations": [
        "Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada"
      ],
      "name": "Shuaib Hafid"
    },
    {
      "affiliations": [
        "ICES, Hamilton, Ontario, Canada"
      ],
      "name": "Anastasia Gayowsky"
    },
    {
      "affiliations": [
        "Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada"
      ],
      "name": "Michelle Howard"
    },
    {
      "affiliations": [
        "Ottawa Hospital Research Institute, Ottawa, Ontario, Canada",
        "Bruyère Research Institute, Ottawa, Ontario, Canada",
        "Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada"
      ],
      "name": "Peter Tanuseputro"
    },
    {
      "affiliations": [
        "ICES, Hamilton, Ontario, Canada",
        "Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada"
      ],
      "name": "Aaron Jones"
    },
    {
      "affiliations": [
        "Ottawa Hospital Research Institute, Ottawa, Ontario, Canada",
        "Bruyère Research Institute, Ottawa, Ontario, Canada"
      ],
      "name": "Mary M Scott"
    },
    {
      "affiliations": [
        "Ottawa Hospital Research Institute, Ottawa, Ontario, Canada",
        "Bruyère Research Institute, Ottawa, Ontario, Canada",
        "Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada"
      ],
      "name": "Amy T Hsu"
    },
    {
      "affiliations": [
        "Ottawa Hospital Research Institute, Ottawa, Ontario, Canada",
        "Bruyère Research Institute, Ottawa, Ontario, Canada",
        "Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada"
      ],
      "name": "James Downar"
    },
    {
      "affiliations": [
        "Ottawa Hospital Research Institute, Ottawa, Ontario, Canada",
        "Bruyère Research Institute, Ottawa, Ontario, Canada",
        "Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada"
      ],
      "name": "Doug Manuel"
    },
    {
      "affiliations": [
        "Department of Medicine, Walker Family Cancer Centre and Niagara Health Sciences, McMaster University, Hamilton, Ontario, Canada"
      ],
      "name": "Katrin Conen"
    },
    {
      "affiliations": [
        "Bruyère Research Institute, Ottawa, Ontario, Canada",
        "Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada",
        "Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Sarina Roslyn Isenberg"
    }
  ],
  "title": "End-of-life interventions in patients with cancer",
  "uid": "ba6c2bb5-3f4c-5bd4-b627-ed87efe9b6c2"
}