Comparison of patient characteristics and end-of-life treatments among cancer descendants between designated cancer care hospitals and non-designated hospitals using the national claims database in Japan.

OBJECTIVE

To compare patient characteristics and end-of-life treatment between designated cancer care hospitals and non-designated hospitals, focusing on non-designated hospitals.

METHODS

We used the National Database from 2013 to 2015, provided by the Ministry of Health, Labor and Welfare.

RESULTS

We analyzed 491 964 patients of cancer descendants (designated hospitals, 164 063 and non-designated hospitals, 327 901). Non-designated hospitals treated older patients, specifically aged 85 years or older (non-designated hospitals: 26% vs designated hospitals: 11%), and fewer patients without comorbidities (32% vs 45%). Regarding end-of-life treatment in the last two weeks, non-designated hospitals had lower palliative care team fees (1% vs 11%; Relative Risk = 0.14), slightly lower use of strong opioids (53% vs 65%; RR = 0.81), and less use of antipsychotics (23% vs 37%; RR = 0.63). Non-designated hospitals used anticancer drugs less frequently (5% vs 10%; RR = 0.51), however, the use of intravenous hydration over 250 mL/day was higher (55% vs 37%; RR = 2.27). In non-designated hospitals, although ICU admission was less frequent (1% vs 5%; RR = 0.27), there was no difference in cardiopulmonary resuscitation (5% vs 5%; RR = 1.02).

CONCLUSIONS

Non-designated hospitals treat more complex patients. In addition, non-designated hospitals had low palliative care team fees, low opioid and other essential drug prescriptions; however, the frequency of artificial hydration was higher. Although non-designated hospitals provided a lower frequency of end-of-life aggressive treatment, no difference was observed in life-sustaining treatments.