High‐intensity end‐of‐life care among children, adolescents, and young adults with cancer who die in the hospital: A population‐based study from the French national hospital database. Issue 13 (26th March 2019)

• Record Type: Journal Article
• Authors: Revon‐Rivière, Gabriel; Pauly, Vanessa; Baumstarck, Karine; Bernard, Cecile; André, Nicolas; Gentet, Jean‐Claude; Seyler, Catherine; Fond, Guillaume; Orleans, Veronica; Michel, Gérard; Auquier, Pascal; Boyer, Laurent
• Is Part Of: Cancer. Volume 125:Issue 13(2019)
• Page Start: 2300
• Page End: 2308
• Publication Date: 2019-03-26
• Subjects: end of life -- cancer -- palliative care -- children -- adolescents -- young adults; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.32035
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : Background: Efforts to improve the quality of end‐of‐life (EOL) care depend on better knowledge of the care that children, adolescents, and young adults with cancer receive, including high‐intensity EOL (HI‐EOL) care. The objective was to assess the rates of HI‐EOL care in this population and to determine patient‐ and hospital‐related predictors of HI‐EOL from the French national hospital database. Methods: This was a population‐based, retrospective study of a cohort of patients aged 0 to 25 years at the time of death who died at hospital as a result of cancer in France between 2014 and 2016. The primary outcome was HI‐EOL care, defined as the occurrence of ≥1 chemotherapy session <14 days from death, receiving care in an intensive care unit ≥1 time, >1 emergency room admission, and >1 hospitalization in an acute care unit in the last 30 days of life. Results: The study included 1899 individuals from 345 hospitals; 61.4% experienced HI‐EOL care. HI‐EOL was increased with social disadvantage (adjusted odds ratio [AOR], 1.30; 95% confidence interval [CI], 1.03‐1.65; P = .028), hematological malignancies (AOR, 2.09; 95% CI, 1.57‐2.77; P < .001), complex chronic conditions (AOR, 1.60; 95% CI, 1.23‐2.09; P = .001) and care delivered in a specialty center (AOR, 1.70; 95% CI, 1.22‐2.36; P = .001). HI‐EOL was reduced in cases of palliative care (AOR, 0.31; 95% CI, 0.24‐0.41; P < .001). Conclusion: A majority of children, adolescents, and young adults experience HI‐EOL care. Several features (eg, social disadvantage, cancer diagnosis, complex chronic conditions, and specialty center care) were associated with HI‐EOL care. These findings should now be discussed with patients, families, and professionals to define the optimal EOL. Abstract : A nationwide population‐based retrospective cohort study of 1899 patients from 345 hospitals reveals that 61.4% of patients received high‐intensity end‐of‐life (HI‐EOL) care. After adjustment, it is shown that HI‐EOL care decreased in cases of palliative care and increased in cases of social disadvantage, hematological malignancies, complex chronic conditions, and specialty center care.