Comparison of patient characteristics and end-of-life treatments among cancer descendants between designated cancer care hospitals and non-designated hospitals using the national claims database in Japan

OBJECTIVE: To compare patient characteristics and end-of-life treatment between designated cancer care hospitals and non-designated hospitals, focusing on non-designated hospitals. METHODS: We used the National Database from 2013 to 2015, provided by the Ministry of Health, Labor and Welfare. RESULTS: We analyzed 491 964 patients of cancer descendants (designated hospitals, 164 063 and non-designated hospitals, 327 901). Non-designated hospitals treated older patients, specifically aged 85 years or older (non-designated hospitals: 26% vs designated hospitals: 11%), and fewer patients without comorbidities (32% vs 45%). Regarding end-of-life treatment in the last two weeks, non-designated hospitals had lower palliative care team fees (1% vs 11%; Relative Risk = 0.14), slightly lower use of strong opioids (53% vs 65%; RR = 0.81), and less use of antipsychotics (23% vs 37%; RR = 0.63). Non-designated hospitals used anticancer drugs less frequently (5% vs 10%; RR = 0.51), however, the use of intravenous hydration over 250 mL/day was higher (55% vs 37%; RR = 2.27). In non-designated hospitals, although ICU admission was less frequent (1% vs 5%; RR = 0.27), there was no difference in cardiopulmonary resuscitation (5% vs 5%; RR = 1.02). CONCLUSIONS: Non-designated hospitals treat more complex patients. In addition, non-designated hospitals had low palliative care team fees, low opioid and other essential drug prescriptions; however, the frequency of artificial hydration was higher. Although non-designated hospitals provided a lower frequency of end-of-life aggressive treatment, no difference was observed in life-sustaining treatments.