Early palliative care reduces aggressive end-of-life care for women with ovarian cancer
Click Here to Manage Email Alerts
Key takeaways:
- Women with ovarian cancer who received palliative care earlier than 3 months before death had less aggressive end-of-life care.
- Early palliative care also appeared linked to a lower ICU admission rate.
Early receipt of palliative care appeared linked to less aggressive end-of-life care for women with ovarian cancer, according to study results.
“Our findings suggest that the timing of palliative care initiation matters,” Sarah J. Mah, MD, MSc, FRCSC, gynecologic oncologist at McMaster University, and colleagues wrote. “As late palliative care initiation may be less effective in improving the quality of end-of-life care and may not be associated with key end-of-life outcomes compared with no palliative care, it may represent a suboptimal use of finite palliative care resources.”
Prior research suggested 30% to 80% of women who die of gynecologic cancer initiate palliative care in the final month of life. This late timing does not allow patients to fully benefit from palliative care, according to researchers.
Mah and colleagues conducted a population-based retrospective cohort study of women who died of ovarian cancer to assess the potential association between the timing of palliative care initiation and the aggressiveness of end-of-life care.
Researchers used linked administrative health care data in Ontario, Canada, to identify palliative care provision across all health care sectors and health care professionals and end-of-life quality indicators.
Researchers included data decedent information from 2006 to 2018.
The associations between timing of palliative care and end-of-life quality indicators — such as whether a patient received chemotherapy in the last 14 days of life, died in the hospital, or went to the ED, hospital or ICU in the final 30 days of life — served as the primary outcome measures.
Researchers defined “late” palliative care as initiation during the final 3 months before death.
The study included 8,297 women who died of ovarian cancer (mean age at death, 69.6 years; mean oncologic survival, 2.8 years).
Of the 3,958 patients with known cancer stage, 3,495 (88.3%) had stage III or IV disease. Additionally, 2,667 patients (32.1%) received late palliative care.
Multivariate regression analysis showed women who initiated palliative care earlier than 3 months before death had lower rates of aggressive end-of-life care (OR = 0.47; 95% CI, 0.37-0.6), death in the hospital (OR = 0.54; 95% CI, 0.45-0.65) and ICU admission (OR = 0.46; 95% CI, 0.27-0.76).
Women who received specialist palliative consultation from 3 months to 6 months before death had decreased likelihood of late chemotherapy (OR = 0.46; 95% CI, 0.24-0.88).
The study data support researchers’ assertion that palliative care is underused, Ada Hsieh, MD, MPH, gynecologic oncology fellow at University of Toronto, and Lilian T. Gien, MD, MSc, affiliate scientist at Sunnybrook Research Institute, wrote in an invited commentary.
“More than 95% of patients had access to palliative care during their gynecologic oncological end-of-life care, and 51% of patients received care from specialist palliative care practitioners,” Hsieh and Gien wrote. “Early initiation of palliative care was associated with decreased aggressive end-of-life care and increased supportive care, which persisted when excluding specialist palliative care data.
“There remain major barriers to palliative care supports, ranging from patients, practitioners and systemic factors,” they added. “How can we improve the acceptance of palliative care such that we can continue to reduce ED visits, hospitalizations and ICU admissions at the end-of-life? We hope that future studies focus on breaking these barriers when introducing multidisciplinary palliative care models.”
References:
- Hsieh A, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.40902.
- Mah SJ, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.40977.
Collapse
Click Here to Manage Email Alerts