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The use of in-hospital medical care for patients with metastasized colon, bronchus, or lung cancer

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

At the end of life, patients and their families tend to favor adequate pain and symptom management and attention to comfort measures over prolongation of life. However, it has been suggested that many cancer patients without curative options still receive aggressive treatment. We therefore aimed to describe the number of diagnostic procedures, hospitalization, and medication use among these patients as well as factors associated with receiving such care.

Methods

We conducted a cohort study on all patients with metastasized cancer from a primary colon or bronchus and lung (BL) neoplasm from the moment of first admittance (January–December 2017) to end of follow-up (November 2018) or death.

Results

A total of 408 patients with colon (36%) or BL (64%) cancer were included in this study, with a median survival time of 7.4 months. 93% of the patients were subjected to at least one diagnostic procedure, 49% received chemotherapy, and 56% received expensive medication including immunotherapy. Patients had a median of 4.6 hospital admissions and 2.3 emergency room (ER) visits. A quarter of all patients (n = 105) received specialized palliative care with a mean of 1.96 consultations and the first consultation after a median time of 4.1 months. Patients with BL neoplasms received significantly more diagnostic procedures, chemotherapy episodes, ER/ICU admissions, and more often received an end-of-life statement per person-year than patients with a primary colon neoplasm. Females received significantly less diagnostic procedures and visited the ER/ICU less frequently than males, and patients aged > 70 years received significantly less chemotherapy (episodes) and expensive medication than younger patients. No differences in care were found between different socioeconomic status groups.

Conclusion

Patients with metastasized colon or BL cancer receive a large amount of in-hospital medical care. Specialized palliative care was initiated relatively late despite the incurable disease status of all patients. Factors associated with more procedures were BL neoplasms, age between 50 and 70, and male gender.

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Data availability

Data are available upon request via wetenschapsbureau@spaarnegasthuis.nl.

Code availability

R-code for this study is available upon request via wetenschapsbureau@spaarnegasthuis.nl.

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Author information

Authors and Affiliations

  1. Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands

    Isabeau S. L. van Brakel, Sjoerd M. Euser & Karlijn J. van Stralen

  2. Department of Epidemiology and Data Science, Amsterdam UMC (Location AMC), University of Amsterdam, Amsterdam, The Netherlands

    Martijn M. Stuiver

  3. Department of Oncology, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands

    Gerty J. de Klerk

  4. Department of Palliative Care, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands

    Gerty J. de Klerk

Authors
  1. Isabeau S. L. van Brakel
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  2. Martijn M. Stuiver
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  3. Sjoerd M. Euser
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  4. Gerty J. de Klerk
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  5. Karlijn J. van Stralen
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by IB, MS, and KvS. The first draft of the manuscript was written by IB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Karlijn J. van Stralen.

Ethics declarations

Ethics approval

Ethics approval in accordance with the Dutch law (WMO) is not necessary for this study. The protocol was approved by the board of directors and the review board of the Spaarne Gasthuis (December 2018).

Consent to participate

According to Dutch law, patients in this retrospective study did not have to provide consent for this study.

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All authors have provided consent for publication.

Competing interests

The authors declare no competing interests.

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Appendix List of add on medication. medications for which separate approval from the Dutch Health Authoryty is need. More information can be found on:

Appendix List of add on medication. medications for which separate approval from the Dutch Health Authoryty is need. More information can be found on:

https://puc.overheid.nl/nza/doc/PUC_272082_22/2/

5-aminolevulinezuur

abatacept

abirateronacetaat

adalimumab

afamelanotide

afatinib

aflibercept

agalsidase alfa

agalsidase beta

alemtuzumab

alglucosidase alfa

amfotericine B in lipidecomplex

amfotericine B liposomaal

amsacrine

anagrelide

anakinra

anidulafungine

apremilast

arseen trioxide

axitinib

azacitidine

bedaquiline

belatacept

belimumab

bendamustine

bevacizumab

bexaroteen

bleomycine

blinatumomab

bortezomib

bosutinib

botulinetoxine

brentuximab vedotin

busulfan

cabazitaxel

canakinumab

capecitabine

carfilzomib

caspofungine

catumaxomab*

ceritinib

certolizumab pegol

cetuximab

chloorambucil

chondrocelect

cisplatine

clofarabine

cobimetinib

collagenase clostridium histolyticum*

corifollitropine (alfa)

crisantaspase

crizotinib

cyclofosfamide

cytarabine

dabrafenib

dasatinib

decitabine

defibrotide

dexamethason

dexrazoxaan

docetaxel

doxorubicine liposomaal PEG

eculizumab

elosulfase alfa*

enzalutamide

epirubicine

eribuline

erlotinib

estramustine

etanercept

etoposide

everolimus

fludarabine

follitropine (alfa)

follitropine alfa/ lutropine alfa

follitropine (bèta)

galsulfase

gefitinib

gemcitabine

golimumab.

gonadoreline

humaan alfa1-proteïnaseremmer

humane insuline

hydroxycarbamide

ibritumomab tiuxetan

ibrutinib

idarubicine

idelalisib

idursulfase

imatinib

immunoglobuline i.v

infliximab

ipilimumab

irinotecan

isavuconazol

ivacaftor

ixekizumab

lapatinib

laronidase

lenalidomide

lenvatinib

levodopa/carbidopa

lomustine

mecasermine

melfalan

menopauzegonadotrofine

mepolizumab

methylaminolevulinaat

micafungine

mifamurtide*

mitomycine

mitotaan

mitoxantron

natalizumab

necitumumab

nelarabine

nilotinib

nintedanib

nivolumab

obinutuzumab

ofatumumab

olaparib

omalizumab

osimertinib

oxaliplatine

paclitaxel

paclitaxel albumine gebonden

palifermin

panitumumab

panobinostat

pazopanib

pegaptanib

pembrolizumab

pemetrexed

pertuzumab

pixantron

plerixafor

pomalidomide

ponatinib

posaconazol

procarbazine

radium-223 chloride*****

ramucirumab

ranibizumab

regorafenib

reslizumab

rituximab

ruxolitinib

secukinumab

siltuximab

somatropine

sorafenib

sunitinib

talimogene laherparepvec

tegafur

temoporfine

temozolomide

temsirolimus

teniposide

thalidomide

thiotepa

tioguanine

tocilizumab

topotecan

trabectedine

trametinib

trastuzumab

trastuzumab-emtansine

tretinoine

urofollitropine

ustekinumab

vandetanib

vedolizumab

vemurafenib

verteporfine

vinblastine

vincristine

vinorelbine

vismodegib

voriconazol

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van Brakel, I.S.L., Stuiver, M.M., Euser, S.M. et al. The use of in-hospital medical care for patients with metastasized colon, bronchus, or lung cancer . Support Care Cancer 29, 6579–6588 (2021). https://doi.org/10.1007/s00520-021-06233-6

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  • DOI: https://doi.org/10.1007/s00520-021-06233-6

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