Palliative care delivery according to age in 12, 000 women with metastatic breast cancer: Analysis in the multicentre ESME-MBC cohort 2008–2016. (September 2020)

• Record Type: Journal Article
• Authors: Frasca, Matthieu; Sabathe, Camille; Delaloge, Suzette; Galvin, Angeline; Patsouris, Anne; Levy, Christelle; Mouret-Reynier, Marie A.; Desmoulins, Isabelle; Vanlemmens, Laurence; Bachelot, Thomas; Goncalves, Anthony; Perotin, Virginie; Uwer, Lionel; Frenel, Jean S.; Ferrero, Jean M.; Bouleuc, Carole; Eymard, Jean C.; Dieras, Véronique; Leheurteur, Marianne; Petit, Thierry; Dalenc, Florence; Jaffre, Anne; Chevrot, Michaël; Courtinard, Coralie; Mathoulin-Pelissier, Simone
• Is Part Of: European journal of cancer. Volume 137(2020)
• Page Start: 240
• Page End: 249
• Publication Date: 2020-09
• Subjects: Palliative care -- Palliative medicine -- Age -- Inpatient care -- Metastatic breast cancer; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2020.07.007
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Introduction: Patients with metastatic breast cancer (MBC) often require inpatient palliative care (IPC). However, mounting evidence suggests age-related disparities in palliative care delivery. This study aimed to assess the cumulative incidence function (CIF) of IPC delivery, as well as the influence of age. Methods: The national ESME (Epidemio-Strategy-Medical-Economical)-MBC cohort includes consecutive MBC patients treated in 18 French Comprehensive Cancer Centres. ICD-10 palliative care coding was used for IPC identification. Results: Our analysis included 12, 375 patients, 5093 (41.2%) of whom were aged 65 or over. The median follow-up was 41.5 months (95% confidence interval [CI], 40.5–42.5). The CIF of IPC was 10.3% (95% CI, 10.2–10.4) and 24.8% (95% CI, 24.7–24.8) at 2 and 8 years, respectively. At 2 years, among triple-negative patients, young patients (<65 yo) had a higher CIF of IPC than older patients after adjusting for cancer characteristics, centre and period (65+/<65: β = −0.05; 95% CI, −0.08 to −0.01). Among other tumour sub-types, older patients received short-term IPC more frequently than young patients (65+/<65: β = 0.02; 95% CI, 0.01 to 0.03). At 8 years, outside large centres, IPC was delivered less frequently to older patients adjusted to cancer characteristics and period (65+/<65: β = −0.03; 95% CI, −0.06 to −0.01). Conclusion: We found a relatively low CIF of IPC and that age influenced IPC delivery. Young triple-negative and older non-triple-negative patients needed more short-term IPCs. Older patients diagnosed outside large centres received less long-term IPC. These findings highlight the need for a wider implementation of IPC facilities and for more age-specific interventions. Highlights: Age was an independent factor of inpatient palliative care (IPC) delivery in metastatic breast cancer (MBC) patients. This association depended on the tumour sub-type and the centre activity. Young HER2-/HR- and older non-triple-negative patients needed more short-term IPC. Older patients diagnosed in large centres more frequently received long-term IPC. A wider implementation of IPC might improve access for older MBC patients.