Annals of Surgical Oncology

, Volume 25, Issue 6, pp 1478–1487 | Cite as

Palliative Care is Associated with Reduced Aggressive End-of-Life Care in Patients with Gastrointestinal Cancer

  • Shaila J. Merchant
  • Susan B. Brogly
  • Craig Goldie
  • Christopher M. Booth
  • Sulaiman Nanji
  • Sunil V. Patel
  • Katherine Lajkosz
  • Nancy N. Baxter
Health Services Research and Global Oncology



We examined the delivery of physician palliative care (PC) services and its association with aggressive end-of-life care (EOLC) in patients with gastrointestinal (GI) cancer in Ontario, Canada.


All patients with primary cause of death from esophageal, gastric, colon, and anorectal cancer from January 2003 to December 2013 were identified. PC services within 2 years of death were classified: (1) any PC; (2) timing of first PC (≤ 7, 8–90, 91–180, and 181–730 days before death); and (3) intensity of PC measured by number of days used (1st–25th, 26th–50th, 51st–75th, and 76th–100th percentiles). Aggressive EOLC was defined as any of the following: chemotherapy, emergency department visits, hospital or intensive care unit (ICU) admissions (all ≤ 30 days of death), and death in hospital and in the ICU; these were combined as a composite outcome (any aggressive EOLC).


The cohort included 34,630 patients, of whom 74% had at least one PC service. Timing of the first PC service varied: ≤ 7 (12%), 8–90 (42%), 91–180 (16%), and 181–730 (30%) days before death. Compared with patients not receiving PC, any PC was associated with a reduction in any aggressive EOLC (risk ratio [RR] 0.75, 95% confidence interval [CI] 0.74–0.76); this association was similar regardless of timing of the first PC service. The most dramatic reduction in aggressive EOLC occurred in patients who received the greatest number of days of PC (RR 0.65, 95% CI 0.63–0.67).


The majority of patients received PC within 2 years of death. A larger number of days of PC was associated with a greater reduction in aggressive EOLC.



This study was funded by the Faculty of Health Sciences Research Initiation Grant (SM) and the Department of Surgery at Queen’s University, and was supported by the ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the CIHI; however, the analyses, conclusions, opinions, and statements expressed herein are those of the authors and not necessarily those of the CIHI.

Author Contributions

All authors contributed to the following elements of the study: conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing of the original draft, and review and editing.




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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Shaila J. Merchant
    • 1
    • 7
  • Susan B. Brogly
    • 1
  • Craig Goldie
    • 2
  • Christopher M. Booth
    • 2
    • 3
  • Sulaiman Nanji
    • 1
  • Sunil V. Patel
    • 1
  • Katherine Lajkosz
    • 4
  • Nancy N. Baxter
    • 5
    • 6
  1. 1.Department of SurgeryQueen’s UniversityKingstonCanada
  2. 2.Department of OncologyQueen’s UniversityKingstonCanada
  3. 3.Cancer Care and EpidemiologyQueen’s Cancer Research InstituteKingstonCanada
  4. 4.Institute for Clinical Evaluative SciencesQueen’s UniversityKingstonCanada
  5. 5.Department of SurgeryLi Ka Shing Knowledge Institute, St. Michael’s HospitalTorontoCanada
  6. 6.Institute for Clinical Evaluative SciencesUniversity of TorontoTorontoCanada
  7. 7.Division of General Surgery and Surgical OncologyKingston Health Sciences CentreKingstonCanada

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