Analysis of end-of-life care between elderly patients with cancer and non-cancer diseases / 中华老年医学杂志

ABSTRACT

Objective:To investigate the clinical characteristics, preferences for cardiopulmonary resuscitation(CPR)and end-of-life care status in elderly patients with cancer vs.non-cancer diseases under geriatric care, and to provide the basis for different elderly groups to carry out palliative care.Methods:Medical records of deceased residents aged ≥60 years from 2014 to 2017 in the department of geriatrics of our hospital were retrospectively reviewed.Data on clinical characteristics, preferences for CPR, application of life-sustaining treatments and end-of-life care were collected.A total of 129 patients were divided into the cancer death group (n=48) and the non-cancer death group (n=81)according to the cause of death.Clinical characteristics and end-of-life care status were compared between the two groups.Results:A total of 129 cases including 98 males(76.0%)and 31 females(24.0%), with a median age of 87(60~100)years and 110 cases(85.3%)aged 80 years and above, were enrolled in this study.The main causes of death were malignant solid tumors(48 cases, 37.2%)and infectious diseases(47 cases, 36.4%). Compared with the cancer death group(n=48), the proportion of patients aged 80 years and above was higher(n=81)(95.1% or 77 cases vs. 68.7% or 33 cases), the proportion of painkiller utilization(5.0% or 4 cases vs. 29.2% or 14 cases)and Charlson Comorbidity Index scores(5.7±2.3 vs.8.9±2.7)were lower in the non-cancer death group( P<0.01). There was no difference in proportions admitted to the intensive care unit, with moderate and severe disability, or with polypharmacy between the two groups( P>0.05). Compared with the cancer death group, the proportions opting for CPR on admission day(70.9% or 56 cases vs. 39.6% or 19 cases), administration of ventilators(38.3% or 38 cases vs. 16.7% or 8 cases)and respiratory stimulants(71.6% or 58 cases vs. 52.1% or 25 cases)were higher in the non-cancer death group( P<0.05). There was no difference in preference for do-not-resuscitate(DNR), utilization of extracardiac compression, electrical defibrillation, tracheotomy, tracheal intubation or vasoactive drugs utilization( P>0.05). Conclusions:The status of hospitalized elderly patients under geriatrics is complex and the burden of end-of-life care is heavy, so it is urgent to practice geriatric palliative care.In addition to focusing on cancer patients, symptom control, early advance care planning (ALP) plans and avoidance of overuse of life-sustaining treatment (LST) at the end stage of non-cancer diseases also need to be addressed.