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End‐of‐Life Practice Patterns in Head and Neck Cancer
Author(s) -
Vukkadala Neelaysh,
Fardeen Touran,
Ramchandran Kavitha,
Divi Vasu
Publication year - 2021
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.29423
Subject(s) - medicine , palliative care , retrospective cohort study , end of life care , head and neck cancer , quality of life (healthcare) , cancer , population , advance care planning , cohort , emergency medicine , family medicine , nursing , environmental health
Objective/Hypothesis Despite the importance of symptom management and end‐of‐life (EOL) care in head and neck cancers (HNC), there is little literature on care practices in this population. This study examines EOL care practice patterns using nationally established metrics. Study Design Retrospective chart review. Methods Review of HNC patients who were actively followed and treated (defined as one clinic note within 90 days, two within preceding 9 months, and having received treatment at our institution) and died between January 1, 2017 and December 31, 2018. The cohort was reviewed for performance on Quality Oncology Practice Initiative (QOPI®) and other metrics. Results Of 133 patients identified, 52 met inclusion criteria. The average age at death was 69.8 years. About 59% had distant metastases, 30% had locoregional disease, 11% were undergoing primary treatment. Twenty‐three percentage received chemotherapy within the last 14 days of life. Fifty percentage of patients were admitted in the last 30 days of life, and 33% died in the hospital. Fifty‐four percentage of patients had either Physician Orders for Life‐Sustaining Treatment or Advanced Directive on file. Eighty‐one percentage of patients had any type of goals of care discussion documented. Sixty‐five percentage of all patients received referrals to palliative care and 46% of all patients enrolled in hospice. The median days in hospice was 12. Having a goals of care discussion was significantly associated with utilization of palliative and hospice care. Conclusions Provider‐documented goals of care discussions were strongly correlated to referrals and enrollment in palliative and hospice care. Areas for improvement include better documentation of treatment directives and reducing low‐utility treatments. Level of Evidence 4 Laryngoscope , 131:1769–1773, 2021