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The COVID-19 pandemic has had a considerable impact on cancer care. Studies have looked at how the pandemic affected palliative care delivery for patients with cancer,1 but little is known on access to palliative care. Besides, aggressiveness of care is prevalent near the end-of-life (EOL) of patients with cancer in France and other countries, and little is known on whether COVID affected this situation.
To address this gap, we conducted an analysis of EOL care intensity and access to palliative care among patients with solid cancer in the Paris area, before and after the initial waves of the COVID-19 pandemic.
Methods
We conducted a retrospective multicentre cohort study on the Clinical Data Warehouse of Greater Paris University Hospitals (Assistance Publique - Hôpitaux de Paris, AP-HP). Our study focused on inpatients with solid metastatic cancer who died in one of AP-HP’s 28 teaching hospitals with data available, between 1 March 2019 and 29 February 2020 (pre-COVID group) and between 1 March 2020 and 28 February 2021 (post-COVID group). Hospital outpatients receiving ambulatory hospital palliative care were excluded. Patients were included if their care history since January 2017 comprised an International Classification of Diseases, 10th edition (ICD-10) code designating metastatic cancer (C78–79) as a primary diagnosis.
Markers of aggressive care defined by Earle et al 2 were extracted from claims data. Diagnoses were coded using the ICD-10, and medical procedures using the French Common Classification of Medical Procedures 11th edition. Referrals to a palliative care team within the last 30, 60 and 90 days of life were identified using ICD-10 code Z515. We computed …
Footnotes
Collaborators *CRAB - Cancer Research Application on Bigdata. Gilles Chatellier, Ariel Cohen, Christel Daniel, Catherine Duclos, Rémi Flicoteaux, Marie Frank, Gilles Galula, Emmanuelle Kempf, Guillaume Lamé, Sonia Priou, Xavier Tannier, Christophe Tournigand and Marie Verdoux.
Contributors EK, TCC and GL designed the study. TCC, MEM and AC performed data analysis. All authors contributed to the interpretation of results. TCC drafted the manuscript, which all authors then revised.
Funding This research was supported by a grant from the AP-HP foundation. MEM’s work on this project was supported by an internship grant from Hub PASREL at Paris Saclay University.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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