Do cancer patients with dementia receive less aggressive treatment in end-of-life care? A nationwide population-based cohort study

// Huei-Kai Huang 1 , Jyh-Gang Hsieh 1, 2 , Chia-Jung Hsieh 3 and Ying-Wei Wang 1, 2 1 Department of Family Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan 2 School of Medicine, Tzu Chi University, Hualien, Taiwan 3 Department of Public Health, Tzu Chi University, Hualien, Taiwan Correspondence to: Ying-Wei Wang, email: drywwang@gmail.com Keywords: cancer, dementia, palliative care, terminal care, end-of-life care Received: January 28, 2017 Accepted: June 02, 2017 Published: June 29, 2017 ABSTRACT Dementia is a progressive, incurable disease that can deprive patients of the ability to make decisions. This study determines whether dementia influences the medical care that a cancer patient receives at the end of life. We conducted a nationwide population-based cohort study on patients aged ≥20 with newly diagnosed cancer during 2000–2012. After matching to reduce confounders, there were 7,111 patients with and 28,444 without dementia. The adjusted odd ratios (OR) for medical interventions, including intensive care, palliative care, invasive procedures, and advanced diagnostic testing, were calculated for the final month and three months of life by a multiple logistic regression model. In the final month before death, the dementia cohort had longer hospital stays (17.7 vs. 17.1 days), more intensive care unit stays (OR = 1.32), and less palliative care (OR = 0.80) than the non-dementia cohort and were more likely to receive invasive procedures, including cardiopulmonary resuscitation (OR = 1.32), endotracheal intubation (OR = 1.27), mechanical ventilation (OR = 1.45), urinary catheterization (OR = 1.24), and feeding tube (OR = 1.88), but less likely to undergo chemotherapy (OR = 0.60) and diagnostic procedures such as computed tomography, magnetic resonance imaging, and sonography (OR = 0.87) or bone scan (OR = 0.69). The analysis examining the three months before death had similar results. In summary, patients with cancer and dementia are more likely to receive intensive care and invasive procedures but less likely to undergo advanced diagnostic testing, chemotherapy, or hospice care than those with cancer but without dementia.