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Symptom Management and Supportive Care

Quality of End-of-Life Care Between Medical Oncologists and Other Physician Specialists for Taiwanese Cancer Decedents, 2001–2006

^aNational Institute of Cancer Research, National Health Research Institutes, Miaoli County, Taiwan; ^bDivision of Hematology-Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan; ^cInstitute of Health and Welfare Policy and ^dInstitute of Public Health, National Yang-Ming University, Taipei, Taiwan; ^eChang Gung University, Graduate School of Nursing, Tao-Yuan, Taiwan, and Nursing Department, Chang Gung Memorial Hospital, Kaohsiung Branch, Kaohsiung, Taiwan

Key Words. Physician specialty • End-of-life care • Quality of care • Medical oncologists

Correspondence: Siew Tzuh Tang, D.N.Sc., Chang Gung University, Graduate School of Nursing, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Taiwan, 333, R.O.C. and, Nursing Department, Chang Gung Memorial Hospital. Kaohsiung Branch. Telephone: 886-3-211-8800-3417; Fax: 886-3-211-8420; e-mail: sttang{at}mail.cgu.edu.tw

Received May 17, 2009; accepted for publication November 20, 2009; first published online in THE ONCOLOGIST Express on December 10, 2009.

Disclosures

Tsang-Wu Liu: None; Jen-Shi Chen: None; Hung-Ming Wang: None; Shiao-Chi Wu: None; Yen-Ni Hung: None; Siew Tzuh Tang: None.

Section editors Eduardo Bruera and Russell Portenoy have disclosed no financial relationships relevant to the content of this article.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias.

Background. Oncologists play a significant role in cancer care throughout the cancer trajectory and have traditionally emphasized underuse of procedures/treatments with well-established effectiveness as the source of poor care quality with little attention to overusing end-of-life (EOL) care. The purpose of this population-based study was to compare the quality of EOL care between medical oncologists and other physician specialists.

Methods. This retrospective cohort study compared indicators of poor quality EOL care by examining administrative data for 204,850 Taiwanese cancer decedents in 2001–2006.

Results. Taiwanese cancer patients whose primary physician was a medical oncologist were significantly more likely than patients of other physician specialists to receive chemotherapy and to spend >14 days in a hospital in the last month of life. However, they were significantly less likely than patients of other physician specialists to visit the emergency room (ER) more than once and to use intensive care unit (ICU) care, cardiopulmonary resuscitation (CPR), intubation, and mechanical ventilation in the last month of life.

Conclusion. The quality of EOL cancer care in Taiwan varied significantly by physician specialty. Cancer decedents cared for by medical oncologists were more likely to receive chemotherapy and prolonged hospitalization but less likely to have multiple ER visits, ICU care, or undergo CPR, intubation, or mechanical ventilation in the last month of life than patients of other physician specialists.