Old age as risk indicator for poor end-of-life care quality - a population-based study of cancer deaths from the Swedish Register of Palliative Care

Background: If patient age affects the quality of end-of-life care in cancer is unknown. Using data from a population-based register of palliative care in Sweden, we addressed this question.

Methods: This nation-wide study focused on the last week of life of adults dying from cancer in 2011-2012, based on data reported to a national quality register for end-of-life care (N=26,976). We specifically investigated if age-dependent differences were present with respect to thirteen indicators of palliative care quality. Patients were categorised in one out of five pre-defined age groups. Odds ratios (OR) with 95% confidence intervals (CIs), adjusted for type of end-of-life care unit, were calculated using logistic regression, with the oldest group as reference.

Findings: Age-dependent differences in implementation rate were detected for ten out of thirteen end-of-life care quality indicators, most of which were progressively less well met with each increment in age group. Compared to elderly cancer patients, young patients were more often informed about imminent death, (OR, 3.9; 95% CI 2.5-5.9, p<0.001), were more often systematically assessed for the presence and severity of pain (OR, 1.6; 95% CI 1.2-2.1, p<0.001) or other symptoms (OR, 1.4; 95% CI 1.0-1.9, p=0.044), were more likely to be assessed by palliative care consultation services (OR, 4.3; 95% CI 3.3-5.7, p<0.001) and to have injections prescribed as needed against pain (OR, 3.4; 95% CI 1.3-9.4, p=0.016), anxiety (OR, 3.8; 95% CI 2.0-7.1, p<0.001) or nausea (OR, 3.6; 95% CI 2.3-5.7, p<0.001). The families of young patients were more likely to be informed about imminent death (OR, 2.6; 95% CI 1.5-4.3, p=0.001) and to be offered bereavement support (OR, 4.6; 95% CI 2.7-7.8, p<0.001).

Interpretation: Old age is a risk indicator for poor end-of-life care quality among cancer patients in Sweden.

Funding: The executive committee of the National Quality Registries in Sweden.