Management and intensity of medical end‐of‐life care in people with colorectal cancer during the year before their death in 2015: A French national observational study

Abstract

The care pathway of patients with colorectal cancer (CRC) 1 year prior to death, their causes of death and the healthcare use, and associated expenditure remain poorly described together. People managed for CRC (2014‐2015), covered by the national health insurance general scheme and who died in 2015 were selected from the national health data system. A total of 15 361 individuals (mean age: 75 years, SD: 12.5 years) were included, almost 66% of whom died in short‐stay hospital (SSH), 9% in hospital at home (HaH), 4% in rehabilitation units (Rehab), 6% in skilled nursing homes (SNH), and 15% at home. At least one other cancer was identified for one‐third of these people. Almost one‐half of people presented cardiovascular comorbidity, 21% had chronic respiratory disease, and 13% had a neurological or degenerative disease. During the last month of life, 83% were admitted at least once to SSH, 39% had at least one emergency department admission, 17% were admitted to an intensive care unit, 15% received at least one chemotherapy session (<60 years: 27%), and 5% received oral chemotherapy. Eighty‐eight percent of the 60% of individuals who received hospital palliative care (HPC) vs 75% of those without HPC were admitted to SSH at least once during the last month. Cancer was the main cause of death for 84% (SSH: 85%, home: 77%) and corresponded to CRC for 64% of them. The mean annual expenditure per person during the last year of life was €43 398 (SSH: €48 804). This study suggests a relatively high level of HPC use during the year before death for people with CRC in France. High rates of emergency department, intensive care, and chemotherapy use were observed during the last month of life. However, management is very largely SSH‐based with a small proportion of deaths at home.

Health care expenditures among long-term survivors of pediatric solid tumors: Results from the French Childhood Cancer Survivor Study (FCCSS) and the French network of cancer registries (FRANCIM)

“…Most of these deaths have been found related to childhood cancer recurrence during the first two decades and to treatment-related sequelae including cardiovascular diseases and second malignant neoplasms, afterward [ 28 ]. The mean expenditures during the last year of life in some types of cancer have been estimated up to 43,000 euros in France [ 29 , 30 ] which correlates well with our results.…”

Chemotherapy use in end-of-life digestive cancer patients: a retrospective AGEO observational study

“…In our work, patients receiving a CT in the last month of their lives died more in medical GI oncology unit than at home or in PCU, as reported in other studies (16,20). Moreover, the delay between transfer to PCU and death was significantly reduced in our patients receiving CT in the month prior to death.…”

“…Association between young age and EOL CT in patients with GI cancer has been previously reported (19,20). In a recent French study carried out with the French social security (CNAM), including 15361 colorectal cancer patients who died in 2015, CT administration in the last month of life concerned 15% of all patients, 26% of patients aged less than 60 years, 18% of patients between 70 and 79 and 7% of patients over 80 years old (20). Several studies suggested that patients with tumors known to be chemo-sensitive may receive more EOL CT than others (18,21,22).…”

“…The influence of age on EOL CT administration may be partly due to difficulties to accept EOL and treatment failure, by young patients themselves, their families, but also the referent physician. Association between young age and EOL CT in patients with GI cancer has been previously reported (19,20). In a recent French study carried out with the French social security (CNAM), including 15361 colorectal cancer patients who died in 2015, CT administration in the last month of life concerned 15% of all patients, 26% of patients aged less than 60 years, 18% of patients between 70 and 79 and 7% of patients over 80 years old (20).…”

Evolution of health care utilization and expenditure during the year before death in 2015 among people with cancer: French snds-based cohort study

“…Average expenditure may also vary according to the cancer type. Several studies based on the same population and methodology reported specific average expenditure during the last year of life (colorectal: €43,400, lung: €43,300, prostate: €38,750, breast: €45,418) [29,36,37]. Our global cancers' HCE are lower than those for specific cancer.…”