Association between multidrug-resistant organism status and quality of end-of-life care in patients with advanced cancer referred to palliative care: a retrospective cohort study with nationwide data linkage.

OBJECTIVES

Multidrug-resistant organisms (MDROs) are becoming increasingly prevalent among patients with advanced cancer referred for palliative care (PC), and may adversely impact the quality of end-of-life care.

METHODS

We conducted a retrospective cohort study of patients with advanced cancer who were referred for PC at a tertiary hospital in South Korea between January 2018 and December 2022 and died before June 2023. Clinical data of patients were linked to nationwide health insurance claims data, enabling comprehensive longitudinal assessment of the end-of-life trajectory beyond a single institution. MDRO status was defined as the detection of resistant organisms in any clinical specimen at the time the patient was referred for PC. Outcomes included utilization of hospice services, in-hospital death at tertiary care centres, receipt of aggressive end-of-life interventions, and total medical costs. Adjusted associations were estimated using logistic and γ regression models.

RESULTS

Among 6151 patients, 523 (8.5%) had MDROs detected. MDRO status was associated with significantly lower use of community-based hospice care, including inpatient hospice (24.1% vs. 37.8%; adjusted odd ratios [aOR], 0.56, 95% CI, 0.45-0.70; p < 0.001) and home hospice (2.7% vs. 7.4%; aOR, 0.39, 95% CI, 0.22-0.67; p = 0.001). It was also associated with more frequent deaths in tertiary hospitals (aOR, 1.74; 95% CI, 1.43-2.12, p < 0.001), and higher intensive care unit admissions (aOR, 2.18; 95% CI, 1.51-3.16, p < 0.001) and renal replacement therapy (aOR, 1.63; 95% CI, 1.03-2.60, p = 0.039). The medical costs were consistently higher in the MDRO group throughout the last 6 months of life.

CONCLUSIONS

MDRO status could be associated with lower quality of end-of-life care, including reduced access to community-based hospice and more aggressive interventions, in patients with advanced cancer referred for PC. These findings underscore the need for infection control strategies that support high-quality, patient-centred care near the end-of-life.