Palliative Care With Tracheostomy or Gastrostomy Tube Use and End-of-Life Quality and Costs Among Patients With Head and Neck Cancer
Notice bibliographique
Résumé
Importance: Patients with head and neck cancer (HNC) have high utilization rates of tracheostomy or gastrostomy tubes (g-tubes) at the end of life, with accompanying high costs. It is unknown whether the timing of palliative care (PC) initiation may attenuate the cost or be associated with better quality of life during the last year and more home deaths. Objective: To assess the association of palliative care (first exposure) and tracheostomy or g-tube utilization with end-of-life costs among patients with head and neck cancer during the last year of life. Design, Setting, and Population: This was a population-based cohort study of adults diagnosed with HNC between January 1, 2007, and December 31, 2022, who died before October 1, 2023, in Ontario, Canada. Health administrative data were deterministically linked and analyzed at the ICES (formerly Institute for Clinical Evaluative Sciences). Data analysis was conducted from January 2024 to June 2025. Exposures: Timing of PC, categorized as early (12 to 6 months before death), late (<6 months before death), and none (no PC during last year of life), was combined with tracheostomy tube use (binary) to form a 6-level categorical variable. This procedure was repeated for g-tube. Main Outcomes: Mean monthly health care costs in last 6 months of life were estimated using a patient-level case-costing algorithm using 2023 CAD$ (CAD$ 1.00 = US$ 0.74) and evaluated by negative binomial regression. Results: The analysis included 11 135 adults who received a diagnosis of HNC from 2007 to 2022 and died before October 1, 2023. They had a mean (SD) age of 68.4 (12.1) years at diagnosis and 8245 were male (74.0%). Nearly 90% received PC: 5866 (52.6%), late PC; 4093 (36.8%), early PC; and 1176 (10.6%) did not receive PC. Regarding tracheostomy/g-tube use in the last year of life, 1293 (11.6%) used a tracheostomy and 1235 (11.1%), a g-tube. Compared to those who did not receive PC nor use a tracheostomy tube, the cost increase on using a tracheostomy tube (rate ratio [RR] 2.93; 95% CI, 2.32-3.71) was higher than using it with early PC (RR, 2.88; 95% CI, 2.63-3.15) but lower than using it with late PC (RR 4.37; 95% CI, 4.00-4.77); results were similar for g-tube use. A large proportion of the cohort had an emergency department visit (9109 [81%]) or a non-PC hospital admission (5419 [48.7%]) in last 6 months of life, with both proportions being the lowest among nonrecipients of PC. Early PC was associated with a 46.8% lower likelihood (odd ratio, 0.53; 95% CI, 0.45-0.63) of experiencing a home death than no PC. Conclusions and Relevance: This cohort study found that receiving a tracheostomy/g-tube in last year of life has pronounced economic implications to the health care system. Early initiation of PC may attenuate this high cost but may not reduce the use of aggressive hospital-based care at the end of life or facilitate home deaths. Team-based early provision of PC for this patient population is required.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».