A Preliminary Survey to Measure the Quality Indicators of End-of-life Cancer Care Using the Japanese National Database

ABSTRACT

Purpose: This survey aimed to develop a methodology for measuring the quality indicators of end-of-life care for cancer patients using the Japanese National Database, which was comprised of the health insurance claim data of all Japanese people. Methods: Life-sustaining treatment (LST) and chemotherapy near the time of death are accepted as reliable indicators of poor quality end-of-life care. To measure these, the Sampling Data Set (SDS) from the National Database (NDB) was used. Results: 1,233 cancer patients were studied, who had died from 14th to 31st October, 2012. The rates of LST and chemotherapy in the final 14 days of life were 8.2% (95%CI 6.7-10.1), 3.5% (2.6-4.8) for inpatients (n=1,079) respectively. In the SDS, 27-70% of chemotherapy drugs were not named, in order to prevent identification of patients receiving rare treatment. Discussion: The figures for rates of chemotherapy might be underestimated in the sampling data set, because of the anonymization of rare treatment. And in-patient and out-patient data may in some cases have been duplicated when entries applied to the same person. In the future using the NDB, it might be possible overcome some of these limitations.