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The Effect of Specialized Palliative Care on End-of-Life Care Intensity in AYAs with Cancer

      Abstract

      Context

      Many adolescents and young adults (AYAs; 15-39 years) with cancer receive high intensity (HI) care at the end of life (EOL). Palliative care (PC) involvement in this population is associated with lower risk of HI-EOL care. Whether this association differs by specialized versus generalist PC (SPC, GPC) is unknown.

      Objectives

      (
      Adolescents and young adults with cancer: National Institute of Health.
      ) To evaluate whether SPC had an impact on the intensity of EOL care received by AYAs with cancer; (
      • Henley SJ
      • Ward EM
      • Scott S
      • Ma J
      • Anderson RN
      • Firth AU
      • et al.
      Annual report to the nation on the status of cancer, part I: National cancer statistics.
      ) to determine which subpopulations are at highest risk for reduced access to SPC.

      Methods

      A decedent cohort of AYAs with cancer who died between 2000-2017 in Ontario, Canada was identified using registry and population-based data. The primary composite measure of HI-EOL care included any of: intravenous chemotherapy <14 days from death; more than one ED visit, more than one hospitalization or any ICU admission <30 days from death. Physician's billing codes were used to define SPC and GPC involvement.

      Results

      Of 7,122 AYA decedents, 2,140 (30%) received SPC and 943 (13%) received GPC. AYAs who died in earlier years, those with hematologic malignancies, males and rural AYAs were least likely to receive SPC. No PC involvement was associated with higher odds of receiving HI-EOL care (odds ratio (OR) 1.5; p<0.0001). However, SPC was associated with the lowest risk of HI-EOL care (OR SPC versus GPC 0.8; p=0.007) and decreased odds of ICU admission (OR 0.7; p=0.006).

      Conclusion

      SPC involvement was associated with the lowest risk of HI-EOL care in AYAs with cancer. However, access to SPC remains a challenge.

      Keywords

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