High-Intensity Care in the End-of-Life Phase of Castration-Resistant Prostate Cancer Patients: Results from the Dutch CAPRI-Registry

Hans Westgeest; Malou Kuppen; Fons A.J.M. Van Den Eertwegh; Ige M. van Oort; Juleon L.L.M. Coenen; Jeroen R.J.A. Van Moorselaar; Katje K.H. Aben; Andre M. Bergman; Daan Ten Bokkel Huinink; Joan Van Den Bosch; Mathijs P. Hendriks; Menuhin I. Lampe; Jules Lavalaye; Niven Mehra; Tineke J. Smilde; Rik D.M. Somford; Lidwine Tick; Nir I. Weijl; Yes A.J. Van De Wouw; Winald R. Gerritsen; CA (Carin) Uyl - de Groot

doi:10.1089/jpm.2020.0800

High-Intensity Care in the End-of-Life Phase of Castration-Resistant Prostate Cancer Patients: Results from the Dutch CAPRI-Registry

Hans Westgeest
, Malou Kuppen
, Fons A.J.M. Van Den Eertwegh
, Ige M. van Oort
, Juleon L.L.M. Coenen
, Jeroen R.J.A. Van Moorselaar
, Katje K.H. Aben
, Andre M. Bergman
, Daan Ten Bokkel Huinink
, Joan Van Den Bosch
, Mathijs P. Hendriks
, Menuhin I. Lampe
, Jules Lavalaye
, Niven Mehra
, Tineke J. Smilde
, Rik D.M. Somford
, Lidwine Tick
, Nir I. Weijl
, Yes A.J. Van De Wouw
, Winald R. Gerritsen

CA (Carin) Uyl - de Groot

Health Technology Assessment (HTA)

Vrije Universiteit Amsterdam
External organisation
Isala Clinics
HolandPTC
The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital
Diakonessenhuis Utrecht
Albert Schweitzer Ziekenhuis
Center for Personalized Cancer Treatment Rotterdam
Northwest Clinics Alkmaar
Medical Centre Leeuwarden
St. Antonius Ziekenhuis
Radboud University Medical Center
Jeroen Bosch Ziekenhuis
Canisius Wilhelmina Hospital
Maxima Medical Centre
Haaglanden Medisch Centrum
VieCuri Medisch Centrum
Amphia Hospital

Research output: Contribution to journal › Article › Academic › peer-review

6 Citations (Scopus)

264 Downloads (Pure)

Abstract

Background: Intensive end-of-life care (i.e., the overuse of treatments and hospital resources in the last months of life), is undesirable since it has a minimal clinical benefit with a substantial financial burden. The aim was to investigate the care in the last three months of life (end-of-life [EOL]) in castration-resistant prostate cancer (CRPC).

Methods: Castration-resistant prostate cancer registry (CAPRI) is an investigator-initiated, observational multicenter cohort study in 20 hospitals retrospectively including patients diagnosed with CRPC between 2010 and 2016. High-intensity care was defined as the initiation of life-prolonging drugs (LPDs) in the last month, continuation of LPD in last 14 days, >1 admission, admission duration ≥14 days, and/or intensive care admission in last three months of life. Descriptive and binary logistic regression analyses were performed.

Results: High-intensity care was experienced by 41% of 2429 patients in the EOL period. Multivariable analysis showed that age (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.97–0.99), performance status (OR 0.57, 95% CI 0.33–0.97), time from CRPC to EOL (OR 0.98, 95% CI 0.97–0.98), referral to a medical oncologist (OR 1.99, 95% CI 1.55–2.55), prior LPD treatment (>1 line OR 1.72, 95% CI 1.31–2.28), and opioid use (OR 1.45, 95% CI 1.08–1.95) were significantly associated with high-intensity care.

Conclusions: High-intensity care in EOL is not easily justifiable due to high economic cost and little effect on life span, but further research is awaited to give insight in the effect on patients' and their caregivers' quality of life.

Original language	English
Pages (from-to)	1789-1797
Number of pages	9
Journal	Journal of Palliative Medicine
Volume	24
Issue number	12
Early online date	19 Aug 2021
DOIs	https://doi.org/10.1089/jpm.2020.0800
Publication status	Published - 17 Nov 2021

Bibliographical note

Funding Information:
This research was funded by Sanofi-Aventis Netherlands B.V., Janssen-Cilag B.V., Astellas Pharma B.V., and Bayer B.V. The funding organizations had no role in the design and conduct of the study, collection, management, analysis, interpretation of the data, and preparation, review, or approval of the abstract.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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10.1089/jpm.2020.0800

jpm.2020.0800Final published version, 157 KBLicence: Article 25fa Dutch Copyright Act

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Westgeest, H., Kuppen, M., Van Den Eertwegh, F. A. J. M., van Oort, I. M., Coenen, J. L. L. M., Van Moorselaar, J. R. J. A., Aben, K. K. H., Bergman, A. M., Ten Bokkel Huinink, D., Van Den Bosch, J., Hendriks, M. P., Lampe, M. I., Lavalaye, J., Mehra, N., Smilde, T. J., Somford, R. D. M., Tick, L., Weijl, N. I., Van De Wouw, Y. A. J., ... Uyl - de Groot, CA. (2021). High-Intensity Care in the End-of-Life Phase of Castration-Resistant Prostate Cancer Patients: Results from the Dutch CAPRI-Registry. Journal of Palliative Medicine, 24(12), 1789-1797. https://doi.org/10.1089/jpm.2020.0800

@article{936ee3f86ec24574999f3a6798f7a3dd,

title = "High-Intensity Care in the End-of-Life Phase of Castration-Resistant Prostate Cancer Patients: Results from the Dutch CAPRI-Registry",

abstract = "Background: Intensive end-of-life care (i.e., the overuse of treatments and hospital resources in the last months of life), is undesirable since it has a minimal clinical benefit with a substantial financial burden. The aim was to investigate the care in the last three months of life (end-of-life [EOL]) in castration-resistant prostate cancer (CRPC). Methods: Castration-resistant prostate cancer registry (CAPRI) is an investigator-initiated, observational multicenter cohort study in 20 hospitals retrospectively including patients diagnosed with CRPC between 2010 and 2016. High-intensity care was defined as the initiation of life-prolonging drugs (LPDs) in the last month, continuation of LPD in last 14 days, >1 admission, admission duration ≥14 days, and/or intensive care admission in last three months of life. Descriptive and binary logistic regression analyses were performed. Results: High-intensity care was experienced by 41\% of 2429 patients in the EOL period. Multivariable analysis showed that age (odds ratio [OR] 0.98, 95\% confidence interval [CI] 0.97–0.99), performance status (OR 0.57, 95\% CI 0.33–0.97), time from CRPC to EOL (OR 0.98, 95\% CI 0.97–0.98), referral to a medical oncologist (OR 1.99, 95\% CI 1.55–2.55), prior LPD treatment (>1 line OR 1.72, 95\% CI 1.31–2.28), and opioid use (OR 1.45, 95\% CI 1.08–1.95) were significantly associated with high-intensity care. Conclusions: High-intensity care in EOL is not easily justifiable due to high economic cost and little effect on life span, but further research is awaited to give insight in the effect on patients' and their caregivers' quality of life.",

author = "Hans Westgeest and Malou Kuppen and \{Van Den Eertwegh\}, \{Fons A.J.M.\} and \{van Oort\}, \{Ige M.\} and Coenen, \{Juleon L.L.M.\} and \{Van Moorselaar\}, \{Jeroen R.J.A.\} and Aben, \{Katje K.H.\} and Bergman, \{Andre M.\} and \{Ten Bokkel Huinink\}, Daan and \{Van Den Bosch\}, Joan and Hendriks, \{Mathijs P.\} and Lampe, \{Menuhin I.\} and Jules Lavalaye and Niven Mehra and Smilde, \{Tineke J.\} and Somford, \{Rik D.M.\} and Lidwine Tick and Weijl, \{Nir I.\} and \{Van De Wouw\}, \{Yes A.J.\} and Gerritsen, \{Winald R.\} and \{Uyl - de Groot\}, \{CA (Carin)\}",

note = "Funding Information: This research was funded by Sanofi-Aventis Netherlands B.V., Janssen-Cilag B.V., Astellas Pharma B.V., and Bayer B.V. The funding organizations had no role in the design and conduct of the study, collection, management, analysis, interpretation of the data, and preparation, review, or approval of the abstract.",

year = "2021",

month = nov,

day = "17",

doi = "10.1089/jpm.2020.0800",

language = "English",

volume = "24",

pages = "1789--1797",

journal = "Journal of Palliative Medicine",

issn = "1096-6218",

publisher = "SAGE Publications Ltd",

number = "12",

}

Westgeest, H, Kuppen, M, Van Den Eertwegh, FAJM, van Oort, IM, Coenen, JLLM, Van Moorselaar, JRJA, Aben, KKH, Bergman, AM, Ten Bokkel Huinink, D, Van Den Bosch, J, Hendriks, MP, Lampe, MI, Lavalaye, J, Mehra, N, Smilde, TJ, Somford, RDM, Tick, L, Weijl, NI, Van De Wouw, YAJ, Gerritsen, WR & Uyl - de Groot, CA 2021, 'High-Intensity Care in the End-of-Life Phase of Castration-Resistant Prostate Cancer Patients: Results from the Dutch CAPRI-Registry', Journal of Palliative Medicine, vol. 24, no. 12, pp. 1789-1797. https://doi.org/10.1089/jpm.2020.0800

TY - JOUR

T1 - High-Intensity Care in the End-of-Life Phase of Castration-Resistant Prostate Cancer Patients

T2 - Results from the Dutch CAPRI-Registry

AU - Westgeest, Hans

AU - Kuppen, Malou

AU - Van Den Eertwegh, Fons A.J.M.

AU - van Oort, Ige M.

AU - Coenen, Juleon L.L.M.

AU - Van Moorselaar, Jeroen R.J.A.

AU - Aben, Katje K.H.

AU - Bergman, Andre M.

AU - Ten Bokkel Huinink, Daan

AU - Van Den Bosch, Joan

AU - Hendriks, Mathijs P.

AU - Lampe, Menuhin I.

AU - Lavalaye, Jules

AU - Mehra, Niven

AU - Smilde, Tineke J.

AU - Somford, Rik D.M.

AU - Tick, Lidwine

AU - Weijl, Nir I.

AU - Van De Wouw, Yes A.J.

AU - Gerritsen, Winald R.

AU - Uyl - de Groot, CA (Carin)

N1 - Funding Information: This research was funded by Sanofi-Aventis Netherlands B.V., Janssen-Cilag B.V., Astellas Pharma B.V., and Bayer B.V. The funding organizations had no role in the design and conduct of the study, collection, management, analysis, interpretation of the data, and preparation, review, or approval of the abstract.

PY - 2021/11/17

Y1 - 2021/11/17

N2 - Background: Intensive end-of-life care (i.e., the overuse of treatments and hospital resources in the last months of life), is undesirable since it has a minimal clinical benefit with a substantial financial burden. The aim was to investigate the care in the last three months of life (end-of-life [EOL]) in castration-resistant prostate cancer (CRPC). Methods: Castration-resistant prostate cancer registry (CAPRI) is an investigator-initiated, observational multicenter cohort study in 20 hospitals retrospectively including patients diagnosed with CRPC between 2010 and 2016. High-intensity care was defined as the initiation of life-prolonging drugs (LPDs) in the last month, continuation of LPD in last 14 days, >1 admission, admission duration ≥14 days, and/or intensive care admission in last three months of life. Descriptive and binary logistic regression analyses were performed. Results: High-intensity care was experienced by 41% of 2429 patients in the EOL period. Multivariable analysis showed that age (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.97–0.99), performance status (OR 0.57, 95% CI 0.33–0.97), time from CRPC to EOL (OR 0.98, 95% CI 0.97–0.98), referral to a medical oncologist (OR 1.99, 95% CI 1.55–2.55), prior LPD treatment (>1 line OR 1.72, 95% CI 1.31–2.28), and opioid use (OR 1.45, 95% CI 1.08–1.95) were significantly associated with high-intensity care. Conclusions: High-intensity care in EOL is not easily justifiable due to high economic cost and little effect on life span, but further research is awaited to give insight in the effect on patients' and their caregivers' quality of life.

AB - Background: Intensive end-of-life care (i.e., the overuse of treatments and hospital resources in the last months of life), is undesirable since it has a minimal clinical benefit with a substantial financial burden. The aim was to investigate the care in the last three months of life (end-of-life [EOL]) in castration-resistant prostate cancer (CRPC). Methods: Castration-resistant prostate cancer registry (CAPRI) is an investigator-initiated, observational multicenter cohort study in 20 hospitals retrospectively including patients diagnosed with CRPC between 2010 and 2016. High-intensity care was defined as the initiation of life-prolonging drugs (LPDs) in the last month, continuation of LPD in last 14 days, >1 admission, admission duration ≥14 days, and/or intensive care admission in last three months of life. Descriptive and binary logistic regression analyses were performed. Results: High-intensity care was experienced by 41% of 2429 patients in the EOL period. Multivariable analysis showed that age (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.97–0.99), performance status (OR 0.57, 95% CI 0.33–0.97), time from CRPC to EOL (OR 0.98, 95% CI 0.97–0.98), referral to a medical oncologist (OR 1.99, 95% CI 1.55–2.55), prior LPD treatment (>1 line OR 1.72, 95% CI 1.31–2.28), and opioid use (OR 1.45, 95% CI 1.08–1.95) were significantly associated with high-intensity care. Conclusions: High-intensity care in EOL is not easily justifiable due to high economic cost and little effect on life span, but further research is awaited to give insight in the effect on patients' and their caregivers' quality of life.

UR - https://www.scopus.com/pages/publications/85121446753

U2 - 10.1089/jpm.2020.0800

DO - 10.1089/jpm.2020.0800

M3 - Article

C2 - 34415798

AN - SCOPUS:85121446753

SN - 1096-6218

VL - 24

SP - 1789

EP - 1797

JO - Journal of Palliative Medicine

JF - Journal of Palliative Medicine

IS - 12

ER -

High-Intensity Care in the End-of-Life Phase of Castration-Resistant Prostate Cancer Patients: Results from the Dutch CAPRI-Registry

Abstract

Bibliographical note

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