Suchergebnisse

ObjectivesThe objective of this study was to describe the receipt of potentially non-beneficial interventions in the last 100 days of life of cancer patients and to examine variations in these interventions according to patient characteristics and cancer site.
ApproachWe conducted a population-based retrospective cohort study of all adults age 18+ who died of cancer in Ontario, Canada between January 1, 2013 and December 31, 2017 using linked administrative health data held at ICES. Potentially non-beneficial interventions were captured via hospital discharge records and included chemotherapy, major surgery, intensive care unit admission, cardiopulmonary resuscitation, defibrillation, dialysis, percutaneous coronary intervention, mechanical ventilation, feeding tube placement, blood transfusion and bronchoscopy. We used bivariate analyses and multivariable Poisson regression to examine associations between the receipt of interventions and decedent age, sex, rurality, area-level income, and cancer site.
ResultsAmong the 125,755 decedents, the most common intervention was blood transfusion (18.1%) and major surgery (12.8%); 23.8% received no interventions, while 14% of decedents received 3+ interventions. Lower intervention rates were observed in older patients (adjusted rate ratio (RR) 0.46, 95% confidence interval (CI) 0.44-0.49 for age 95+ vs. 19-44), females (RR 0.93, 95% CI 0.92-0.94), and individuals living in higher income areas (RR 0.96, 95% CI 0.95-0.98 for highest vs. lowest income quintile). Higher intervention rates were observed in rural patients (RR 1.13, 95% CI 1.11-1.14). Patients with pancreatic cancer had the highest intervention rate (RR 1.13, 95% CI 1.10-1.16), while breast cancer patients had the lowest intervention rate (RR 0.86, 95% CI 0.84-0.89) compared to colorectal cancer patients.
ConclusionPotentially non-beneficial interventions were common in the last 100 days of life of patients with cancer. Variations in interventions across patient demographics and cancer site may reflect differences in healthcare access, end-of-life care preferences, patients' prognostic awareness, and disease factors.

Objective and ApproachThe Canadian Longitudinal Study on Aging (CLSA) is the largest national longitudinal cohort study, following ~50,000 adults across 10 provinces for at least 20 years. Health Data Research Network (HDRN) Canada is a distributed pan-Canadian network including members in all 13 provinces and territories. In February 2021, the organizations partnered with the objective to provide researchers with efficient access to multi-regional CLSA data linked to other health/health-related data through HDRN Canada's data centres. A Steering Committee was convened including representatives from all parties to oversee the process from data sharing agreements (DSAs), negotiating terms of access, through to data transfer and linkage.
ResultsIn Spring 2024, linkage was complete at four data centres (Ontario, New Brunswick, British Columbia, and Nova Scotia), with a DSA also in place for Newfoundland and Labrador. DSAs are nearing approval at three others (Manitoba, Prince Edward Island, and Quebec), and in progress in Alberta. Saskatchewan is working towards participation.
ConclusionsThe HDRN Canada-CLSA partnership is on the way to making linked provincial CLSA cohort data available in all participating jurisdictions, facilitated by streamlined agreements and processes.
ImplicationsCollaborative efforts of organizations such as HDRN Canada and CLSA to foster data linkages and streamline data access at a multi-regional level offers an unparalleled opportunity to explore the intersection between aging and health care utilization. Research enabled by this initiative will inform health care decision making and evidence-based policy development at multiple levels, from the individual to multiple levels of government.