Duration of palliative care involvement and cancer care aggressiveness near the end of life

Abstract

ObjectivesPrevious studies have found an association between aggressive cancer care and lower quality end of life. Despite international recommendations, late or very late referral to palliative care seems frequent. This study aimed to evaluate the association between the duration of involvement of a palliative care team (PCT), and aggressive cancer care, and to identify factors associated with aggressive cancer care.MethodsWe performed an observational retrospective study in a single academic teaching hospital. In total, 561 inpatients with solid tumours or haematological malignancies were included. Patients followed by a PCT for at least 1 month before death were classified in the palliative care group. Aggressive cancer care was defined as: hospitalisations and/or a new line of chemotherapy within the last month of life, location of death, the use of chemotherapy in the last 2 weeks and hospice admissions within the last 3 days of life.ResultsAmong the 561 patients, 241 (43%) were referred to the PCT; 89 (16%) were followed by the PCT for a month or more before death. In the last 2 weeks of life, 124 (22%) patients received chemotherapy, 110 (20%) died in an acute care unit. At least one criterion of aggressive cancer care was found in 395 patients overall (71%). Aggressive cancer care was significantly less frequent when the PCT referral occurred >1 month before death (p<0.0001).ConclusionMore studies are needed to understand reasons for late referrals despite international recommendations encouraging integrative palliative care.Ethics approvalThe study was approved by the Grenoble Teaching Hospital ethics committee, and by the CNIL (French national commission for data privacy; Commission Nationale de l’Informatique et des Libertés) under the number 1987785 v 0. Due to ethical and legal restrictions, data are only available on request.

Quality of End-of-Life Care for People with Advanced Non-Small Cell Lung Cancer in Ontario: A Population-Based Study

“…We found that receipt of palliative care consultation one month or more before death was associated with less aggressive care compared to patients who did not receive a palliative care consult. This finding is congruent with previous literature [ 48 , 49 ].…”

“…Finally, we found that 56% of the cohort did not receive palliative care consultation before death. This is problematic as it is known that patients receiving palliative care consultation have better symptom control, death preparation, less aggressive care and overall quality of death [ 47 , 48 ]. It is encouraging to note that access to palliative care consultation before death increased in all time categories over the study period; moreover, the proportion of early palliative care consultation (defined as >60 days before death) increased from 34% of all consultations for patients dying in 2009, to 44% in 2017 [ 21 ].…”

Association between Consultation by a Comprehensive Integrated Palliative Care Program and Quality of End-of-Life Care in Patients with Advanced Cancer in Edmonton, Canada

“…The authors also noted high heterogeneity of study design, precluding meta-analysis. Subsequent to this review, several studies favoring palliative care's association with decreased aggressiveness of care at the EOL have emerged [20,21,26,27]. For example, Conlon et al conducted a propensity matched cohort study using administrative data of an ambulatory service at a cancer center in Sudbury, Canada and concluded that the palliative care group had lower rates of nearly all indicators of aggressive care at the EOL (absolute risk reduction 12.73%, 95% CI 12.65-12.81).…”

“…The palliative care program at the CCI is a component of this greater program and its consultation procedures are aligned. This integrated organization of palliative care services differs from most of the settings in which aggressive care at the EOL has been studied, which have largely been limited to within-cancer center [10], within-hospital [20] or home-based care in the community [21].…”

The Paradigm Shift from End of Life to Pre-Emptive Palliative Care in Patients with Cancer

“…In most countries, health care providers have circumscribed palliative care in a network represented by home care and hospice care. This is equivalent to a short period, a few weeks before death [ 1 ], thus, assuming that palliative care is equivalent to end-of life care [ 2 ]. Although these services have a relevant role, they partially cover the needs of cancer patients requiring palliative care expertise.…”