Quality of end-of-life cancer care in Canada: a retrospective four-province study using administrative health care data

  • L. Barbera Odette Cancer Centre, University of Toronto and Institute for Clinical Evaluative Sciences
  • H. Seow Institute for Clinical Evaluative Sciences and McMaster University
  • R. Sutradhar Institute for Clinical Evaluative Sciences
  • A. Chu Institute for Clinical Evaluative Sciences
  • F. Burge Dalhousie University
  • K. Fassbender University of Alberta
  • K. McGrail University of British Columbia
  • B. Lawson Dalhousie University
  • Y. Liu Institute for Clinical Evaluative Sciences
  • R. Pataky BC Cancer Research Centre
  • A. Potapov University of Alberta
Keywords: Palliative care, quality indicators, health services research

Abstract

Background

The quality of data comparing care at the end of life (eol) in cancer patients across Canada is poor. This project used identical cohorts and definitions to evaluate quality indicators for eol care in British Columbia, Alberta, Ontario, and Nova Scotia.

Methods

This retrospective cohort study of cancer decedents during fiscal years 2004–2009 used administrative health care data to examine health service quality indicators commonly used and previously identified as important to quality eol care: emergency department use, hospitalizations, intensive care unit admissions, chemotherapy, physician house calls, and home care visits near the eol, as well as death in hospital. Crude and standardized rates were calculated. In each province, two separate multivariable logistic regression models examined factors associated with receiving aggressive or supportive care.

Results

Overall, among the identified 200,285 cancer patients who died of their disease, 54% died in a hospital, with British Columbia having the lowest standardized rate of such deaths (50.2%). Emergency department use at eol ranged from 30.7% in Nova Scotia to 47.9% in Ontario. Of all patients, 8.7% received aggressive care (similar across all provinces), and 46.3% received supportive care (range: 41.2% in Nova Scotia to 61.8% in British Columbia). Lower neighbourhood income was consistently associated with a decreased likelihood of supportive care receipt.

Interpretation

We successfully used administrative health care data from four Canadian provinces to create identical cohorts with commonly defined indicators. This work is an important step toward maturing the field of eol care in Canada. Future work in this arena would be facilitated by national-level data-sharing arrangements.


Author Biographies

L. Barbera, Odette Cancer Centre, University of Toronto and Institute for Clinical Evaluative Sciences
Department of Radiation Oncology
H. Seow, Institute for Clinical Evaluative Sciences and McMaster University
Department of Oncology
F. Burge, Dalhousie University
Department of Family Medicine
K. Fassbender, University of Alberta
Department of Oncology, Division of Palliative Care Medicine
K. McGrail, University of British Columbia
Centre for Health Services and Policy Research, School of Population and Public Health
B. Lawson, Dalhousie University
Department of Family Medicine
R. Pataky, BC Cancer Research Centre
Canadian Centre for Applied Research in Cancer Control
A. Potapov, University of Alberta
Department of Oncology, Division of Palliative Care Medicine
Published
2015-07-14
How to Cite
Barbera, L., Seow, H., Sutradhar, R., Chu, A., Burge, F., Fassbender, K., McGrail, K., Lawson, B., Liu, Y., Pataky, R., & Potapov, A. (2015). Quality of end-of-life cancer care in Canada: a retrospective four-province study using administrative health care data. Current Oncology, 22(5), 341-355. https://doi.org/10.3747/co.22.2636
Section
Palliative Care