Living situation, healthcare utilization and total healthcare costs the six months prior to death for all cancer decedents in Norway: are there differences between the most common cancer deaths?
Gudrun Bjørnelv1,2, Terje Hagen1, Leena Forma3 and Eline Aas1,4
1 Institute of Health and Society, University of Oslo, Oslo, Norway
2 Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
3 Faculty of Social Sciences, Tampere University, Tammerfors, Finland
4 Health Service Research Unit, Akershus University Hospital, Lørenskog, Norway
Background: Annually, approximately 11,000 people die from cancer in Norway, which is the leading cause of death. People dying from cancer are heterogeneous regarding factors such as age, gender, comorbidity, type of cancer, and access to informal care. Most research of end-of-life care utilization focus on single aspects of care (i.e., only on hospital care, primary care or home- and community based care, or only informal care), and frequently, research is performed on selected cohorts (i.e., only in the elderly). Because of the integrated nature of palliative care, all aspects at end-of-life needs to be evaluated simultaneously, in non-selected cohorts. Aim:
In the current paper, our aim was to describe the living situation, healthcare utilization and healthcare costs in all levels of the sector 6 months prior to death, for all cancer decedents in Norway between 2009–2013.
Methods: We linked 6 national registers, and describe the no. days patient lived at home, in short- or long- term institutions or in the hospital. We describe their use of secondary (inpatient and outpatient care), primary (GP and ER consultations) and home- and community-based care (practical and nursing assistance) and estimate the cost in the different levels of the sectors (NOK 2016). To estimate the difference in living
situation, healthcare utilization and healthcare cost, depending on the type of cancer patients died from (lung-, colorectal-, prostate-, breast-, cervical- and other cancer) and other sociodemographic factors (age, gender, marital status, education, income and comorbidities), we used appropriate regression models, i.e., Negative binomial (for healthcare utilization) and generalized linear models (for healthcare costs). Results: In total, 52,926 individuals died from cancer in Norway between 2009-2013; 16% from lung, 12% from colorectal, 9%
from prostate, 6% from breast and 1% from cervical cancer. On average, patients spend 123 days at home, 24 days in hospital, 16 days in short-term care and 24 days in long-term care during their last 6 months of life.
Overall, patient’s healthcare utilization increased towards their end-of-life, such as patients use of inpatient care, GP and ER-visits, and hours of practical or nursing assistance (in the home). Between the different causes of cancer, healthcare utilization varied somewhat – thus – the healthcare costs also varied between them both in the secondary (min/max NOK175,578/NOK233,471), primary (min/max NOK9,737-NOK13,982) and home- and community based care setting (min/max NOK128,917/191,283). However, the healthcare costs varied more between individuals depending on their age and access to informal care (marital status), than their underlying cause of death (type of cancer); increasing age reduced secondary care but increases home- and community-based care, while access to informal care increased the use of secondary care while it decreased the use of home- and community-based care. Those with higher education and income used some more secondary, but some less primary- and home- and community-based care, but the total healthcare utilization was
relatively similar across different education and income levels. Conclusion: The type of cancer patients die from influences the no. of days patients spend at home, and their healthcare utilization and healthcare costs.
However, a patients age and access to informal care, influences the patients end-of-life more than what the type of cancer does.
