Data from: Novel methods to define invasive procedures at the end-of-life were developed to improve quality of end of life care research: A population-based cohort study in colorectal cancer

Background Understanding the use of invasive procedures (IPs) at the
end-of-life (EoL) is important to avoid under- and overtreatment, but
epidemiologic analysis is hampered by limited methods to define treatment
intent and EoL phase. This study applied novel methods to report IPs at
the EoL using a colorectal cancer (CRC) case study. Methods An English
population-based cohort of adult patients diagnosed between 2013 and 2015
was used with follow-up to 2018. Procedure intent (curative, non-curative,
diagnostic) by cancer site and stage at diagnosis was classified by two
surgeons independently. Joinpoint regression modelled weekly rates of IPs
for 36 sub-cohorts of patients with incremental survival of 0-36 months.
EoL phase was defined by a significant IP rate change before death.
Zero-inflated Poisson regression explored associations between IP rates
and clinical/sociodemographic variables. Results Of 87,731 patients
included, 41,972 (48%) died. 9,492 procedures were classified by intent
(interrater agreement 99.8%). Patients received 502,895 IPs (1.39 and 3.36
per person year for survivors and decedents). Joinpoint regression
identified significant increases in IPs four weeks before death in those
living 3-6 months, and eight weeks before death in those living 7–36
months from diagnosis. 7,908 (18.8%) patients underwent IPs at the EoL,
with stoma formation the most common major procedure. Younger age,
early-stage disease, men, lower comorbidity, those receiving chemotherapy
and living longer from diagnosis were associated with IPs. Conclusions
Methods to identify and classify IPs at the EoL were developed and tested
within a CRC population. This approach can be now extended and validated
to identify potential under- and overtreatment.