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Original research
Duration of palliative care involvement and cancer care aggressiveness near the end of life
  1. Pierre Antoine Monier1,
  2. Jan Chrusciel2,
  3. Fiona Ecarnot3,4,
  4. Eduardo Bruera5,
  5. Stephane Sanchez2 and
  6. Cecile Barbaret1,6
  1. 1Department of Supportive and Palliative Care, Centre Hospitalo-Universitaire de Grenoble, Grenoble, France
  2. 2Department of Public Health and Performance, Hôpitaux Champagne Sud, Troyes, France
  3. 3Department of Cardiology, University Hospital Besançon, Besancon, France
  4. 4EA3920, University of Burgundy Franche-Comté, Besançon, France
  5. 5Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  6. 6Laboratoire ThEMAS (Techniques pour l’évaluation et la Modélisation des Actions de Santé) TIMC-IMAG (Technique de l’Ingénierie Médicale et de la Compléxité-Informatique, Mathématiques et Applications, Grenoble), Grenoble, France
  1. Correspondence to Dr Cecile Barbaret, isere, Centre Hospitalier Universitaire de Grenoble, 38043 Grenoble, France; cbarbaret{at}chu-grenoble.fr

Abstract

Objectives Previous studies have found an association between aggressive cancer care and lower quality end of life. Despite international recommendations, late or very late referral to palliative care seems frequent. This study aimed to evaluate the association between the duration of involvement of a palliative care team (PCT), and aggressive cancer care, and to identify factors associated with aggressive cancer care.

Methods We performed an observational retrospective study in a single academic teaching hospital. In total, 561 inpatients with solid tumours or haematological malignancies were included. Patients followed by a PCT for at least 1 month before death were classified in the palliative care group. Aggressive cancer care was defined as: hospitalisations and/or a new line of chemotherapy within the last month of life, location of death, the use of chemotherapy in the last 2 weeks and hospice admissions within the last 3 days of life.

Results Among the 561 patients, 241 (43%) were referred to the PCT; 89 (16%) were followed by the PCT for a month or more before death. In the last 2 weeks of life, 124 (22%) patients received chemotherapy, 110 (20%) died in an acute care unit. At least one criterion of aggressive cancer care was found in 395 patients overall (71%). Aggressive cancer care was significantly less frequent when the PCT referral occurred >1 month before death (p<0.0001).

Conclusion More studies are needed to understand reasons for late referrals despite international recommendations encouraging integrative palliative care.

Ethics approval The study was approved by the Grenoble Teaching Hospital ethics committee, and by the CNIL (French national commission for data privacy; Commission Nationale de l’Informatique et des Libertés) under the number 1987785 v 0. Due to ethical and legal restrictions, data are only available on request.

  • cancer
  • end of life care
  • quality of life
  • terminal care

https://doi.org/10.1136/bmjspcare-2020-002641

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    Footnotes

    • PAM and JC contributed equally.

    • Contributors CB, PAM contributed to study concept and design; acquisition of data; JC, SS contributed to statistical analysis; CB, JC, SS, PAM, EB, FE contributed to analysis and interpretation of data; CB, SS, EB, JC, PAM contributed to

      drafting of the manuscript; CB, EB, SS, FE contributed to

      critical revision of the manuscript for important intellectual content. CB had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the Grenoble Teaching Hospital ethics committee, and by the CNIL (French national commission for data privacy; Commission Nationale de l’Informatique et des Libertés) under the number 1987785 v 0. Due to ethical and legal restrictions, data are only available on request.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. Due to ethical and legal restrictions, data are only available on request. In order to resquest research data, a formal request should be made to AccueilRecherche@chu-grenoble.fr.