Comparing Noncancer and Cancer Deaths in Hong Kong: A Retrospective Review

• Published in: Journal of pain and symptom management 2010-11, Vol.40 (5), p.704-714
• Main Authors: Lau, Kam Shing, MD, Tse, Doris Man Wah, MD, Tsan Chen, Tracy Wai, MD, Lam, Po Tin, MD, Lam, Wai Man, MD, Chan, Kin Sang, MD
• Format: Article
• Language: English
• Subjects: Adult; advance care planning; Aged; Aged, 80 and over; Anesthesia & Perioperative Care; Biological and medical sciences; Cancer; cancer deaths; Chinese people; Chronic obstructive pulmonary disease; Death; end-of-life care; Female; Health Services - statistics & numerical data; Health Services - utilization; Heart Failure - therapy; Hong Kong; Humans; Male; Medical sciences; Middle Aged; Neoplasms - therapy; Noncancer deaths; Pain Medicine; Palliative care; Palliative Care - statistics & numerical data; Palliative Care - utilization; Pharmacology. Drug treatments; Pulmonary Disease, Chronic Obstructive - therapy; Retrospective Studies; Symptoms; Terminal Care - statistics & numerical data; Terminal Care - utilization
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2010.02.023

Abstract This retrospective study aimed to compare noncancer deaths with cancer deaths in the following: 1) utilization of the public health care system in the last six months of life; 2) end-of-life care received; and 3) documentation of the advance care planning (ACP) process. The following sample was recruited from the deaths in 2006 in four public hospitals for analysis: 656 noncancer deaths consisting of 239 deaths from chronic renal failure (CRF), 242 deaths from chronic obstructive pulmonary disease (COPD) and 175 deaths from congestive heart failure (CHF), and 183 cancer deaths. Only 1.4% of noncancer patients received palliative care, compared with 79.2% of cancer patients. As compared with cancer, the noncancer patients were older (79.1 ± 9.5 vs. 71.1 ± 12.4 years, P < 0.001) and had more comorbid conditions (2.3 ± 1.4 vs. 1.6 ± 1.4, P < 0.001). Utilization of public health care was more intensive in noncancer patients, with more intensive care unit admissions, more ward admissions, more bed days occupied, and more clinic attendances. Within the last two weeks of life, the noncancer patients had more invasive interventions initiated, fewer symptoms documented, less analgesics and sedatives prescribed, less do-not-resuscitate orders in place, and more cardiopulomonary resuscitation performed. Dyspnea, edema, pain, and fatigue were among the most documented symptoms in both cancer and noncancer patients. A higher proportion of ACP discussions were first documented within three days before death in COPD and CHF patients as compared with CRF and cancer patients. There is a need to develop palliative care for noncancer patients in Hong Kong.