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Hospital end-of-life care aggressiveness in adult solid tumour patients pre and post COVID-19: retrospective multicentre cohort study
  1. Tanya Cassam Chenai1,
  2. Mohamed El Mejdani2,
  3. Ariel Cohen3,
  4. Sonia Priou2,
  5. Gilles Chatellier4,5,
  6. Rémi Flicoteaux6,
  7. Alaa Mhalla7,
  8. Christophe Tournigand1,
  9. Emmanuelle Kempf1,8 and
  10. Guillaume Lamé2
  11. on behalf of the Assistance Publique – Hôpitaux de Paris (AP-HP) Cancer Group, a CRAB* initiative
    1. 1Department of medical oncology, Université Paris Est Créteil, Assistance Publique – Hôpitaux de Paris, Henri Mondor and Albert Chenevier Teaching Hospital, Créteil, France
    2. 2Laboratoire Génie Industriel, Université Paris-Saclay, CentraleSupélec, Gif-sur-Yvette, France
    3. 3Innovation and Data, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, France
    4. 4Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, France
    5. 5Paris Cité University, Paris, Île-de-France, France
    6. 6Département d'Information Médicale, Assistance Publique - Hopitaux de Paris, Paris, Île-de-France, France
    7. 7Department of palliative care, Henri Mondor and Albert Chenevier Teaching Hospital, Université Paris Est Créteil, Assistance Publique – Hôpitaux de Paris, Créteil, France
    8. 8Laboratoire d’Informatique Médicale et d’Ingénierie des Connaissances pour la e-Santé, Sorbonne Universite, Paris, Île-de-France, France
    1. Correspondence to Dr Guillaume Lamé, CentraleSupelec, Gif-sur-Yvette, France; guillaume.lame{at}centralesupelec.fr

    https://doi.org/10.1136/spcare-2024-004888

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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 al2 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 …

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      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.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.