Trends in the Aggressiveness of End-of-Life Cancer Care in the State of Qatar

Abstract

Introduction: The quality of end-of-life (EOL) care is becoming recognized as a key component of excellence in cancer care. Monitoring these quality indicators is crucial to provide continuing excellence in cancer care. Objectives: The aim of this study was to describe trends in the aggressiveness of EOL cancer care in Qatar and to compare our findings with those reported in North America. Methods: This retrospective, population-based cohort study analyzed all cancer deaths in Qatar between January 1, 2009 and December 31, 2013 to measure martkers of EOL cancer care. Aggressiveness of EOL care was then examined by a composite measure adapted from Earle et al. with scores ranging from 0 to 7, in which higher scores indicate more aggressive EOL care. Results: The proportion of patients who experienced at least one event of potentially aggressive EOL cancer care decreased during the 5-year study period from 82.3% to 71.0% (p=0.038). The mean composite score for the aggressiveness of EOL care was 2.10 (mean)+/-0.77 (standard deviation), decreasing significantly from 2.24 in 2009 to 1.92 in 2013 (p<0.01). This change can be attributed to significantly reduced proportions of more than one ER visits and ICU admissions within 30 days of death since 2009. Conclusions: The aggressiveness of EOL cancer care has decreased over time in Qatar, whereas the North American trends are increasing. Although trends are decreasing in Qatar, the overall rates of these measures are higher than those in North America.