CONTEXT: Patients with advanced breast cancer have low rates of survival that can be associated with symptom burden.
OBJECTIVES: This study seeks to characterize the effect of longitudinally-collected symptom scores on predicting time to death for advanced breast cancer patients.
METHODS: A cohort of 993 Stage IV breast cancer patients was constructed using linked population-level health administrative databases that captured longitudinally-collected symptom data using the Edmonton Symptom Assessment System. Data was captured on individual symptom scores (20,371 assessments) for pain, tiredness, drowsiness, nausea, appetite, dyspnea, depression, anxiety and wellbeing, as well as three summative scores of total symptom distress score (TSDS), physical symptom score, and psychological symptom score. A joint modelling approach was undertaken to simultaneously model repeated measures longitudinal data and time-to-event data.
RESULTS: Of patients who died in the study, 56.11% survived for a mean time of less than three years and had lower mean symptom scores for all symptoms except shortness of breath, in comparison to patients who lived for greater than three years. Symptom burden was predictive of patient time to death for all symptoms, with risk of death increasing with worsening symptom scores. For TSDS, age at diagnosis (0.009, p<0.05), chemotherapy (-0.63, p<0.001) and palliative care (3.15, p<0.001) were significant predictors of patient time to death.
CONCLUSIONS: Patients with advanced breast cancer experience chronic, ongoing low symptom burden which predicts patient time to death. Future research should examine the mechanisms by which patient characteristics, treatment, supportive and palliative care can have an impact on patient survival.
BACKGROUND: Socioeconomic disparities in home death have been noted in the literature. Home-based palliative care increases access to home death and has been suggested as a means to decrease these disparities.
AIM: Our study examines the association between socioeconomic status and other demographic factors on place of death in a population receiving home palliative care in Toronto, Canada.
DESIGN: This is a retrospective chart review of patients who died between August 2013 and August 2015 when admitted to a home-based palliative care service. Multivariate multinomial regression examined the relationship between the place of death (home, palliative care unit [PCU], or acute care) with age, gender, primary diagnosis, and income quintile. Bivariate logistic regression was fitted to calculate the odds ratio (OR) and probability of preference for home death.
SETTING/PARTICIPANTS: Patients receiving home-based palliative care services from the Latner Centre for Palliative Care in Toronto, Canada.
RESULTS: A total of 2066 patients were included in multivariate analysis. Patients in the lowest income quintile had increased odds of dying in acute care (OR = 2.41, P < .001) or dying in PCU (OR = 1.64, P = .008) than patients in highest income quintile. Patients in the next lowest income quintiles 2 and 3 were also more likely to die in acute care. The rate of preference for home death was significantly lower in the lowest income quintile (OR = 0.47, P = .0047).
CONCLUSIONS: Patients in lower income quintiles are less likely to die at home, despite receiving home-based palliative care, although they may also be less likely to prefer home death.