Originally published as JCO Early Release 10.1200/JCO.2005.16.493 on September 12 2005

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Aabom, B. Articles by Stovring, H. Search for Related Content PubMed PubMed Citation Articles by Aabom, B. Articles by Stovring, H. Related Articles Related Editorial Social Bookmarking                            What's this?

Defining Cancer Patients As Being in the Terminal Phase: Who Receives a Formal Diagnosis, and What Are the Effects?

From the Research Units of General Practice, Health Economics, and Epidemiology, Institute of Public Health, University of Southern Denmark, Odense, Denmark

Address reprint requests to B. Aabom, MD, Research Unit of General Practice, J.B. Winsloevs Vej 9A, DK-5000 Odense C, Denmark; e-mail: baabom{at}health.sdu.dk

PURPOSE: Physicians either do not define cancer patients as being terminal, or their prognostic estimates tend to be optimistic. This might affect patients' appropriate and timely referral to specialist palliative care services or can lead to unintended acute hospitalization.

PATIENTS AND METHODS: We used the Danish Cancer Register and four administrative registers to perform a retrospective cohort study in 3,445 patients who died as a result of cancer. We used the Danish "terminal declaration" issued by a physician as a proxy for a formal terminal diagnosis (prognosis of death within 6 months). The terminal declaration gives right to economic benefits and increased care for the dying. We investigated patient-related factors of receiving an explicit terminal diagnosis by logistic regression and then analyzed the effects of such a diagnosis on admission rate per week and place of death.

RESULTS: Thirty-four percent of patients received a formal terminal diagnosis. Age of 70 years (odds ratio [OR], 0.44; 95% CI, 0.34 to 0.56; P < .001), women (OR, 0.81; 95% CI, 0.69 to 0.96; P = .02), hematologic cancer (OR, 0.20; 95% CI, 0.09 to 0.41; P < .001), and a less than 1-month survival time (OR, 0.10; 95% CI, 0.07 to 0.15; P < .001) were associated with a lesser likelihood of receiving a formal terminal diagnosis. Explicit terminal diagnosis was associated with lower admission rate and an adjusted OR of hospital death of 0.25 (95% CI, 0.21 to 0.29).

CONCLUSION: Women and the elderly were less likely to receive a formal terminal diagnosis. The formal terminal diagnosis reduced hospital admissions and increased the possibilities of dying at home.

Supported by the Health Insurance Foundation (Grants No. 2001B116 and 2002B025), the Danish Research Foundation for General Practice (Grant No. 586-193259), and the Danish College of General Practitioners' Foundation for Research in General Practice 2001.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Editorial

• Improving the Care of Terminally Ill Cancer Patients and Their Families
  Eduardo Bruera
  JCO 2005 23: 7378-7379 [Full Text]

This article has been cited by other articles:

				S Innes and S Payne Advanced cancer patients' prognostic information preferences: a review Palliative Medicine, January 1, 2009; 23(1): 29 - 39. [Abstract] [PDF]

				R. T. Penson, F. Gu, S. Harris, M. M. Thiel, N. Lawton, A. F. Fuller Jr., and T. J. Lynch Jr. Hope Oncologist, September 1, 2007; 12(9): 1105 - 1113. [Abstract] [Full Text] [PDF]

				S. Gripp, S. Moeller, E. Bolke, G. Schmitt, C. Matuschek, S. Asgari, F. Asgharzadeh, S. Roth, W. Budach, M. Franz, et al. Survival Prediction in Terminally Ill Cancer Patients by Clinical Estimates, Laboratory Tests, and Self-Rated Anxiety and Depression J. Clin. Oncol., August 1, 2007; 25(22): 3313 - 3320. [Abstract] [Full Text] [PDF]

				J. S. Temel, V. A. Jackson, J. A. Billings, C. Dahlin, S. D. Block, M. K. Buss, P. Ostler, P. Fidias, A. Muzikansky, J. A. Greer, et al. Phase II Study: Integrated Palliative Care in Newly Diagnosed Advanced Non-Small-Cell Lung Cancer Patients J. Clin. Oncol., June 10, 2007; 25(17): 2377 - 2382. [Abstract] [Full Text] [PDF]

				E. Bruera Improving the Care of Terminally Ill Cancer Patients and Their Families J. Clin. Oncol., October 20, 2005; 23(30): 7378 - 7379. [Full Text] [PDF]