Locus-of-care disparities in end-of-life care intensity among adolescents and young adults with cancer: A population-based study using the IMPACT cohort.
adolescent
cancer
health services research
population-based
young adult
Journal
Cancer
ISSN: 1097-0142
Titre abrégé: Cancer
Pays: United States
ID NLM: 0374236
Informations de publication
Date de publication:
15 01 2022
15 01 2022
Historique:
revised:
10
08
2021
received:
20
06
2021
accepted:
30
08
2021
pubmed:
16
9
2021
medline:
11
3
2022
entrez:
15
9
2021
Statut:
ppublish
Résumé
Adolescents and young adults (AYAs) with cancer may experience elevated rates of high-intensity end-of-life (HI-EOL) care. Locus-of-care (LOC) disparities (pediatric vs adult) in AYA end-of-life (EOL) care are unstudied. A decedent population-based cohort of Ontario AYAs diagnosed between 1992 and 2012 at the ages of 15 to 21 years was linked to administrative data. The authors determined the prevalence and associations of a composite outcome of HI-EOL care that included any of the following: intravenous chemotherapy within 14 days of death, more than 1 emergency department visit, more than 1 hospitalization, or an intensive care unit (ICU) admission within 30 days of death. Secondary outcomes included measures of the most invasive EOL care (ventilation within 14 days of death and ICU death) and in-hospital death. There were 483 decedents: 60.5% experienced HI-EOL care, 20.3% were ventilated, and 22.8% died in the ICU. Compared with patients with solid tumors, patients with hematological malignancies had the greatest odds of HI-EOL care (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.5-3.4), ventilation (OR, 4.7; 95% CI, 2.7-8.3), and ICU death (OR, 4.4; 95% CI, 2.6-4.4). Subjects treated in pediatric centers versus adult centers near death (OR, 2.4; 95% CI, 1.2-4.8) and those living in rural areas (OR, 2.1; 95% CI, 1.1-3.9) were more likely to experience ICU death. AYAs with cancer experience high rates of HI-EOL care, with patients in pediatric centers and those living in rural areas having the highest odds of ICU death. This study is the first to identify LOC-based disparities in EOL care for AYAs, and it highlights the need to explore the mechanisms underlying these disparities.
Sections du résumé
BACKGROUND
Adolescents and young adults (AYAs) with cancer may experience elevated rates of high-intensity end-of-life (HI-EOL) care. Locus-of-care (LOC) disparities (pediatric vs adult) in AYA end-of-life (EOL) care are unstudied.
METHODS
A decedent population-based cohort of Ontario AYAs diagnosed between 1992 and 2012 at the ages of 15 to 21 years was linked to administrative data. The authors determined the prevalence and associations of a composite outcome of HI-EOL care that included any of the following: intravenous chemotherapy within 14 days of death, more than 1 emergency department visit, more than 1 hospitalization, or an intensive care unit (ICU) admission within 30 days of death. Secondary outcomes included measures of the most invasive EOL care (ventilation within 14 days of death and ICU death) and in-hospital death.
RESULTS
There were 483 decedents: 60.5% experienced HI-EOL care, 20.3% were ventilated, and 22.8% died in the ICU. Compared with patients with solid tumors, patients with hematological malignancies had the greatest odds of HI-EOL care (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.5-3.4), ventilation (OR, 4.7; 95% CI, 2.7-8.3), and ICU death (OR, 4.4; 95% CI, 2.6-4.4). Subjects treated in pediatric centers versus adult centers near death (OR, 2.4; 95% CI, 1.2-4.8) and those living in rural areas (OR, 2.1; 95% CI, 1.1-3.9) were more likely to experience ICU death.
CONCLUSIONS
AYAs with cancer experience high rates of HI-EOL care, with patients in pediatric centers and those living in rural areas having the highest odds of ICU death. This study is the first to identify LOC-based disparities in EOL care for AYAs, and it highlights the need to explore the mechanisms underlying these disparities.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
326-334Subventions
Organisme : C17 Research Network
Organisme : CIHR
Pays : Canada
Organisme : Alex's Lemonade Stand Foundation for Childhood Cancer
ID : Young Investigator Grant
Organisme : CIHR
Pays : Canada
Informations de copyright
© 2021 American Cancer Society.
Références
Bleyer A, Choi M, Fuller CD, Thomas CR Jr, Wang SJ. Relative lack of conditional survival improvement in young adults with cancer. Semin Oncol. 2009;36:460-467. doi:10.1053/j.seminoncol.2009.07.004
Gupta S, Pole JD, Baxter NN, et al. The effect of adopting pediatric protocols in adolescents and young adults with acute lymphoblastic leukemia in pediatric vs adult centers: an IMPACT cohort study. Cancer Med. 2019;8:2095-2103. doi:10.1002/cam4.2096
Gupta S, Baxter NN, Hodgson D, et al. Treatment patterns and outcomes in adolescents and young adults with Hodgkin lymphoma in pediatric versus adult centers: an IMPACT cohort study. Cancer Med. 2020;9:6933-6945. doi:10.1002/cam4.3138
Bleyer A. The death burden and end-of-life care intensity among adolescent and young adult patients with cancer. JAMA Oncol. 2015;1:579-580. doi:10.1001/jamaoncol.2015.2038
Earle CC, Park ER, Lai B, Weeks JC, Ayanian JZ, Block S. Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol. 2003;21:1133-1138. doi:10.1200/jco.2003.03.059
Earle CC, Neville BA, Landrum MB, et al. Evaluating claims-based indicators of the intensity of end-of-life cancer care. Int J Qual Health Care. 2005;17:505-509. doi:10.1093/intqhc/mzi061
Earle CC, Neville BA, Landrum MB, Ayanian JZ, Block SD, Weeks JC. Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol. 2004;22:315-321. doi:10.1200/jco.2004.08.136
Kiefe CI, Weissman NW, Allison JJ, Farmer R, Weaver M, Williams OD. Identifying achievable benchmarks of care: concepts and methodology. Int J Qual Health Care. 1998;10:443-447. doi:10.1093/intqhc/10.5.443
Wright AA, Zhang B, Ray A, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008;300:1665-1673. doi:10.1001/jama.300.14.1665
Earle CC, Landrum MB, Souza JM, Neville BA, Weeks JC, Ayanian JZ. Aggressiveness of cancer care near the end of life: is it a quality-of-care issue? J Clin Oncol. 2008;26:3860-3866. doi:10.1200/jco.2007.15.8253
Ho TH, Barbera L, Saskin R, Lu H, Neville BA, Earle CC. Trends in the aggressiveness of end-of-life cancer care in the universal health care system of Ontario, Canada. J Clin Oncol. 2011;29:1587-1591. doi:10.1200/jco.2010.31.9897
Kassam A, Sutradhar R, Widger K, et al. Predictors of and trends in high-intensity end-of-life care among children with cancer: a population-based study using health services data. J Clin Oncol. 2017;35:236-242. doi:10.1200/JCO.2016.68.8283
Revon-Riviere G, Pauly V, Baumstarck K, et al. High-intensity end-of-life care among children, adolescents, and young adults with cancer who die in the hospital: a population-based study from the French national hospital database. Cancer. 2019;125:2300-2308. doi:10.1002/cncr.32035
Tzuh Tang S, Hung YN, Liu TW, et al. Pediatric end-of-life care for Taiwanese children who died as a result of cancer from 2001 through 2006. J Clin Oncol. 2011;29:890-894. doi:10.1200/jco.2010.32.5639
Rajeshuni N, Johnston EE, Saynina O, Sanders LM, Chamberlain LJ. Disparities in location of death of adolescents and young adults with cancer: a longitudinal, population study in California. Cancer. 2017;123:4178-4184. doi:10.1002/cncr.30860
Johnston EE, Alvarez E, Saynina O, Sanders L, Bhatia S, Chamberlain LJ. End-of-life intensity for adolescents and young adults with cancer: a Californian population-based study that shows disparities. J Oncol Pract. 2017;13:e770-e781. doi:10.1200/JOP.2016.020586
Mack JW, Chen LH, Cannavale K, Sattayapiwat O, Cooper RM, Chao CR. End-of-life care intensity among adolescent and young adult patients with cancer in Kaiser Permanente Southern California. JAMA Oncol. 2015;1:592-600. doi:10.1001/jamaoncol.2015.1953
Mack JW, Chen K, Boscoe FP, et al. High intensity of end-of-life care among adolescent and young adult cancer patients in the New York State Medicaid program. Med Care. 2015;53:1018-1026. doi:10.1097/MLR.0000000000000437
Benchimol EI, Smeeth L, Guttmann A, et al. The Reporting of Studies Conducted Using Observational Routinely-Collected Health Data (RECORD) statement. PLoS Med. 2015;12:e1001885. doi:10.1371/journal.pmed.1001885
Adolescents and young adults with cancer. National Cancer Institute. Accessed April 22, 2020. https://www.cancer.gov/types/aya
Baxter NN, Daly C, Gupta S, et al. The Initiative to Maximize Progress in Adolescent and Young Adult Cancer Therapy (IMPACT) cohort study: a population-based cohort of young Canadians with cancer. BMC Cancer. 2014;14:805. doi:10.1186/1471-2407-14-805
Greenberg ML, Barr RD, DiMonte B, McLaughlin E, Greenberg C. Childhood cancer registries in Ontario, Canada: lessons learned from a comparison of two registries. Int J Cancer. 2003;105:88-91. doi:10.1002/ijc.11004
Widger K, Sutradhar R, Rapoport A, et al. Predictors of specialized pediatric palliative care involvement and impact on patterns of end-of-life care in children with cancer. J Clin Oncol. 2018;36:801-807. doi:10.1200/jco.2017.75.6312
Editorial guidelines. SAS Institute, Inc. Accessed April 2, 2020. https://www.sas.com/en_ca/legal/editorial-guidelines.html
Mack JW, Cannavale K, Sattayapiwat O, et al. Care in the final month of life among adolescent and young adult cancer patients in Kaiser Permanente Southern California. J Palliat Med. 2016;19:1136-1141. doi:10.1089/jpm.2015.0527
Avery J, Geist A, D'Agostino NM, et al. “It's more difficult…”: clinicians' experience providing palliative care to adolescents and young adults diagnosed with advanced cancer. J Oncol Pract. 2019;16:e100-e108. doi:10.1200/jop.19.00313
Keim-Malpass J, Erickson JM, Malpass HC. End-of-life care characteristics for young adults with cancer who die in the hospital. J Palliat Med. 2014;17:1359-1364. doi:10.1089/jpm.2013.0661
Jacobs S, Perez J, Cheng YI, Sill A, Wang J, Lyon ME. Adolescent end of life preferences and congruence with their parents' preferences: results of a survey of adolescents with cancer. Pediatr Blood Cancer. 2015;62:710-714. doi:10.1002/pbc.25358
Durall A, Zurakowski D, Wolfe J. Barriers to conducting advance care discussions for children with life-threatening conditions. Pediatrics. 2012;129:e975-e982. doi:10.1542/peds.2011-2695
Bleyer A, Barr R. Cancer in young adults 20 to 39 years of age: overview. Semin Oncol. 2009;36:194-206. doi:10.1053/j.seminoncol.2009.03.003
LeBlanc TW, Egan PC, Olszewski AJ. Transfusion dependence, use of hospice services, and quality of end-of-life care in leukemia. Blood. 2018;132:717-726. doi:10.1182/blood-2018-03-842575
Egan PC, LeBlanc TW, Olszewski AJ. End-of-life care quality outcomes among Medicare beneficiaries with hematologic malignancies. Blood Adv. 2020;4:3606-3614. doi:10.1182/bloodadvances.2020001767
El-Jawahri A, LeBlanc TW, Kavanaugh A, et al. Effectiveness of integrated palliative and oncology care for patients with acute myeloid leukemia: a randomized clinical trial. JAMA Oncol. 2021;7:238-245. doi:10.1001/jamaoncol.2020.6343
Pritchard S, Cuvelier G, Harlos M, Barr R. Palliative care in adolescents and young adults with cancer. Cancer. 2011;117(suppl):2323-2328. doi:10.1002/cncr.26044