{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T11:48:02Z","timestamp":1784029682406,"version":"3.55.0"},"reference-count":41,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,12,20]],"date-time":"2019-12-20T00:00:00Z","timestamp":1576800000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["#1R01AG045441"],"award-info":[{"award-number":["#1R01AG045441"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["T32AG023480"],"award-info":[{"award-number":["T32AG023480"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2020,3,15]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>This study examined factors associated with potentially burdensome end\u2010of\u2010life (EOL) transitions between care settings among older adults with advanced cancer in nursing homes (NHs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective analysis of deceased older NH residents with poor\u2010prognosis solid tumors was conducted with Medicare claims and the Minimum Data Set. A potentially burdensome transition was defined as 2 or more hospitalizations or an intensive care unit admission in the last 90\u00a0days of life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 34,670 subjects, many had moderate to severe cognitive impairment (53.8%), full dependence in activities of daily living (ADLs; 66.5%), and comorbidities such as congestive heart failure (CHF; 29.3%) and chronic obstructive pulmonary disease (34.1%). Only 56.3% of the patients used hospice at any time in the 90\u00a0days before death; 36.0% of the patients experienced a potentially burdensome EOL transition, and this was higher among patients who did not receive hospice (45.4% vs 28.7%; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01). In multivariable analyses, full dependence in ADLs (odds ratio [OR], 1.70; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01), CHF (OR, 1.48; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01), and chronic obstructive pulmonary disease (OR, 1.28; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01) were associated with a higher risk of burdensome EOL transitions. Those with do\u2010not\u2010resuscitate directives (OR, 0.60; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01) and impaired cognition (OR, 0.89; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01) had lower odds of burdensome EOL transitions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>NH residents with advanced cancer have substantial comorbidities and functional impairment, yet more than a third experience potentially burdensome EOL transitions. These findings help to identify a population at risk for poor EOL outcomes in order to target interventions, and they point to the importance of advanced care planning in this population.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.32658","type":"journal-article","created":{"date-parts":[[2019,12,20]],"date-time":"2019-12-20T09:21:46Z","timestamp":1576833706000},"page":"1322-1329","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Potentially burdensome end\u2010of\u2010life transitions among nursing home residents with poor\u2010prognosis cancer"],"prefix":"10.1002","volume":"126","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6170-2597","authenticated-orcid":false,"given":"Daniel E.","family":"Lage","sequence":"first","affiliation":[{"name":"Division of Hematology and Oncology, Department of Medicine Massachusetts General Hospital Cancer Center and Harvard Medical School Boston 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Medicine Massachusetts General Hospital Cancer Center and Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan L.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Hinda and Arthur Marcus Institute for Aging Research Hebrew SeniorLife and Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7268-5921","authenticated-orcid":false,"given":"Jennifer S.","family":"Temel","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, Department of Medicine Massachusetts General Hospital Cancer Center and Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3556-1495","authenticated-orcid":false,"given":"Areej","family":"El\u2010Jawahri","sequence":"additional","affiliation":[{"name":"Division of Hematology and 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Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,12,20]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2014.0280"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djt025"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1100347"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.8981"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.291.1.88"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30700"},{"key":"e_1_2_8_8_1","first-page":"1","article-title":"Long\u2010term care providers and services users in the United States: data from the National Study of Long\u2010Term Care Providers, 2013\u20102014","volume":"3","author":"Harris\u2010Kojetin L","year":"2016","journal-title":"Vital Health 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