Comparing characteristics, advance care planning, and end-of-life trajectories in deceased nursing home residents with and without cancer – Results from the German ‘Gut-Leben’ project

INTRODUCTION: Nursing home residents with cancer face particularly high needs for end-of-life care compared to those without cancer. This study aims to examine differences in characteristics, advance care planning (ACP) consultations, and end-of-life trajectories between deceased nursing home residents with and without cancer. MATERIALS AND METHODS: We conducted a cross-sectional study in 15 ACP-approved nursing homes in Lower Saxony, Germany. Data on deceased residents were collected by nursing homes from October 2023 to September 2024, immediately following each death. Information included resident characteristics, prevalence of cancer and other comorbidities at death, ACP consultations, documented end-of-life care preferences, and end-of-life trajectories including medical treatment as well as circumstances of dying. Descriptive analyses compared residents with and without cancer, and logistic regression models were used to determine factors associated with ACP consultations. RESULTS: Data from 342 deceased residents (mean age 84.6 years; 54% female) were analyzed, including 75 (22%) with cancer. Residents with cancer had significantly shorter survival after nursing home admission (median 227 vs. 661 days; p < 0.05), were younger, and had fewer diagnoses of dementia, renal insufficiency, and stroke. ACP consultations were equally common in both groups (40% vs. 39%; p = 0.91), but residents with cancer less frequently completed ACP processes (68% vs. 85%; p = 0.04) and less frequently documented preferences (56% vs. 81%; p = 0.004). Multivariable logistic regression showed no association between cancer diagnosis and ACP consultation (OR 0.92; 95% CI 0.49-1.72). End-of-life trajectories were largely comparable between residents with and without cancer, with 52% having at least one hospitalization in the last month of life and 25% dying in hospital for both groups. DISCUSSION: Despite higher needs for end-of-life care and shorter survival, nursing home residents with cancer were not more likely to receive ACP, differentiated end-of-life treatment, or tailored care compared to those without cancer. These findings highlight a structural care gap and emphasize the urgent need to timely integrate ACP for nursing home residents with cancer.