Quality of end-of-life care for women with gynecologic malignancies in Ontario, Canada: A 14-year population-based retrospective analysis (132)

Objectives: Tracking population-based quality indicators of supportive and aggressive end of life (EOL) care may provide insight into the success of EOL interventions and health resource utilization. We examined patterns of EOL care in patients with gynecologic cancers over 14 years in Ontario, Canada. Methods: We conducted a population-based, retrospective cohort study of gynecologic cancer decedents in Ontario from 2005 to 2018 using linked administrative healthcare data (Ontario Cancer Registry, Discharge Abstract Database, Ontario Health Insurance Plan physician billing claims, homecare databases). Quality indices included emergency department (ED) use, admissions to hospital or intensive care unit (ICU), chemotherapy in the last 14 days of life, physician or palliative care home visits, and death in hospital, as well as previously defined aggregate measures of aggressive or supportive care. Descriptive statistics and crude incidence rates of each indicator were calculated. A multivariable logistic regression model was created to examine the relationship between sociodemographic and patient factors and receipt of aggressive and supportive care. Results: The cohort included 1 7,405 women; 51% died of ovarian cancer, 30% uterine cancer, 12% cervical cancer, and 6.5% vulvar or vaginal cancers (VVC). During the study period, death rates in hospitals decreased from 48% to 39%, while supportive care indices increased from 47% to 71%, and aggressive care indices remained stable (18%). Within the last 30 days of life, 53% were hospitalized, 5.6% were admitted to ICU, and 64% accessed palliative homecare, while within the last 14 days of life, 33% visited the ED, and 4.5% received chemotherapy. Patients with VVC demonstrated lower rates of both aggressive (11%) and supportive care (58%) compared to other cancer subtypes. On multivariable analyses, patients were significantly more likely to receive aggressive EOL care if they were <50 years of age, had a modified Deyo-Charlson Comorbidity Index score of 0, had uterine or ovarian cancer, or lived in a smaller community (<100,000) or a neighborhood in the lowest three income quintiles. Patients were less likely to receive supportive EOL care if they were ≥70 years of age, had a non-ovarian gynecologic malignancy, or lived in the lowest two income quintiles. Objectives: Tracking population-based quality indicators of supportive and aggressive end of life (EOL) care may provide insight into the success of EOL interventions and health resource utilization. We examined patterns of EOL care in patients with gynecologic cancers over 14 years in Ontario, Canada. Methods: We conducted a population-based, retrospective cohort study of gynecologic cancer decedents in Ontario from 2005 to 2018 using linked administrative healthcare data (Ontario Cancer Registry, Discharge Abstract Database, Ontario Health Insurance Plan physician billing claims, homecare databases). Quality indices included emergency department (ED) use, admissions to hospital or intensive care unit (ICU), chemotherapy in the last 14 days of life, physician or palliative care home visits, and death in hospital, as well as previously defined aggregate measures of aggressive or supportive care. Descriptive statistics and crude incidence rates of each indicator were calculated. A multivariable logistic regression model was created to examine the relationship between sociodemographic and patient factors and receipt of aggressive and supportive care. Results: The cohort included 1 7,405 women; 51% died of ovarian cancer, 30% uterine cancer, 12% cervical cancer, and 6.5% vulvar or vaginal cancers (VVC). During the study period, death rates in hospitals decreased from 48% to 39%, while supportive care indices increased from 47% to 71%, and aggressive care indices remained stable (18%). Within the last 30 days of life, 53% were hospitalized, 5.6% were admitted to ICU, and 64% accessed palliative homecare, while within the last 14 days of life, 33% visited the ED, and 4.5% received chemotherapy. Patients with VVC demonstrated lower rates of both aggressive (11%) and supportive care (58%) compared to other cancer subtypes. On multivariable analyses, patients were significantly more likely to receive aggressive EOL care if they were <50 years of age, had a modified Deyo-Charlson Comorbidity Index score of 0, had uterine or ovarian cancer, or lived in a smaller community (<100,000) or a neighborhood in the lowest three income quintiles. Patients were less likely to receive supportive EOL care if they were ≥70 years of age, had a non-ovarian gynecologic malignancy, or lived in the lowest two income quintiles.