Access to palliative care for cancer patients between diagnosis and death: a national cohort study

Abstract

Asmaa Janah,1 Lynn R Gauthier,2 Lucas Morin,3 Philippe Jean Bousquet,1,4 Christine Le Bihan,4 Philippe Tuppin,5 Patrick Peretti-Watel,6 Marc-Karim Bendiane11Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information (SESSTIM), Marseille, France; 2Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval - Centre Hospitalier Universitaire de Québec-Université Laval Research Centre, Oncology Division and Équipe de recherche Michel-Sarrazin en oncologie psychosociale et soins palliatifs, Université Laval Cancer Research Centre, Québec, Canada; 3Aging Research Center, Karolinska Institutet, Stockholm, Sweden; 4Survey, Monitoring and Assessment Department, Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute - INCa), Boulogne Billancourt, France; 5Département des études sur les pathologies et les patients (DEPP), Caisse Nationale d’Assurance Maladie, Paris, France; 6Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, and ORS PACA, Southeastern Health Regional Observatory, Marseille, FranceBackground and purpose: Introducing palliative care earlier in the disease trajectory has been found to provide better management of physical and psychological suffering. In France, the proportion of cancer patients who receive palliative care is unclear. This study aimed primarily to measure the prevalence of access to inpatient palliative care and associated patient-level factors, and to identify the time between access to palliative care and death.Patients and methods: A nationwide retrospective cohort study using data from the French national health system database (SNDS). All those diagnosed with cancer in 2013 who died between 2013 and 2015 were included. Access to inpatient palliative care was the main outcome.Results: Of the 313,059 patients diagnosed with cancer in 2013 in France, 72,315 (23%) died between 2013 and 2015. Overall, 57% had access to inpatient palliative care. The following groups were the most likely to have access to palliative care: women (adjusted odds ratio, aOR: 1.15; 95% CI: 1.11–1.20), people aged 18–49 (aOR: 1.38; 95% CI: 1.26–1.51), individuals with metastatic cancer (aOR: 2.04; 95% CI: 1.96–2.13), and patients with cancer of the nervous system (aOR: 1.80; 95% CI: 1.62–2.01). The median time between palliative care and death was 29 (interquartile range: 13–67) days.Conclusion: More than half of cancer patients who died within 2 years after diagnosis had access to inpatient palliative care. Access to palliative care occurs late in the disease trajectory, often during the final month of life. Further research and guidelines are warranted to optimize access to early, standardized palliative care.Keywords: French national health system database, palliative care, cancer, death, factors, timing

Keywords

• French national health system database
• palliative care
• cancer
• death
• factors
• timing