Bridging the Gap: Transforming Knowledge into Action
July 8-12, 2006, Washington, DC, USA
Tuesday, 11 July 2006 - 12:00 PM 169-2
Complications at the End-of-Life in Ovarian Cancer
Lisa J. Herrinton, PhD1, Christine Neslund-Dudas, PhD2, Sharon J. Rolnick, PhD3, Mark C. Hornbrook, PhD4, Donald J. Bachman, MS4, Jeanne A. Darbinian, MPH1, Jody M. Jackson, RN, BSN3, and Steven S. Coughlin, PhD5. (1) Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, (2) Henry Ford Health Systems, 1 Ford Place, 3A, Detroit, MI 48202, (3) HealthPartners Research Foundation, PO Box 1309, 8100 34th Avenue South, Minneapolis, MN 55440, (4) Center for Health Research, Northwest/Hawaii, Kaiser Permanente, 3800 North Interstate Avenue, Portland, OR 97227, (5) Division of Cancer Prevention and Control, US Centers for Disease Control and Prevention, 4770 Buford Highway, NE (K-55), Atlanta, GA 30309
Background: The spectrum of health care that dying ovarian cancer patients receive is heterogeneous. Objective: The objective of this study was to describe the complications of ovarian cancer and their treatment at the end-of-life for women in the managed-care setting. Methods: Cohort study of 421 women who died with ovarian cancer during 1995-2000 while enrolled in one of three non-profit managed care organizations. Data collection consisted of linkage with computerized information and abstraction of medical records. Measures: Proportions of women experiencing complications and undergoing treatments were calculated. Logistic regression was used to evaluate the association of age with the probability of receiving an intervention during the last 6 months of life. Results: The most common complications recorded during the last 6 months of life were fatigue and weakness (75%), nausea and vomiting (71%), constipation (49%), edema of the extremities (44%), and anemia (34%). The most common major complications included ascites (28%), pleural effusion (10%), bowel obstruction (12%), bladder obstruction (3%), and disorders of nutrition, ranging to parenteral nutrition support (9%). Women did not always receive interventions for these complications; e.g., pleural effusion may have been left untreated in half of women with this problem. After adjustment, younger women were more likely to receive an intervention (compared with older women, odds ratio for each decade of age, 0.71, 95% confidence interval, 0.53-0.94). Conclusion: The study of care practices delivered during 1995-2000 suggests that palliative care given to ovarian cancer patients at the end of life may have been inadequate, based upon recorded medical information.