Palliative care involvement and intensity of end-of-life care among adolescents and young adults with cancer: a population-based study 

1. In this cohort of adolescents and young adults (AYAs), getting palliative care from a specialist palliative physician is associated with significantly less aggressive end-of-life treatment. 

Evidence Rating Level: 2 (Good) 

Adolescents and young adults (AYAs) between the ages of 15-39 years with cancer have unique medical, psychosocial, and financial needs and often experience high symptom burden and intensive end-of-life care. Although early palliative care can improve quality of life and reduce aggressive end-of-life interventions, many AYAs receive limited palliative support because of stigma and misconceptions. Building on Canada’s 2017 Action Plan to improve access to palliative care, this retrospective cohort study aims to examine how frequently AYAs in Ontario receive palliative care services and how such improvement influences the intensity of their medical care at the end of life. The intensity of end-of-life care was assessed using indicators such as chemotherapy in the last 14 days, ICU admission, hospitalizations, and location of death (hospital, ICU, palliative care unit, community, or other). A total of 1981 AYAs were included, with 76% receiving palliative care in the last 90 days of life, and 89% of these encounters involved specialist palliative care physicians. Compared with generalist or no palliative care, specialist involvement was associated with greater admission rates (58% vs 57% vs 47%, p=0.0004), but lower use of mechanical ventilation (12% vs 36% vs 33%, p<0.0001), fewer hospital deaths (42% vs 64% vs 56%, p<0.0001), and fewer ICU deaths (12% vs 38% vs 38%, p<0.0001). Palliative care use among AYAs with cancer in Ontario has increased; however, many still receive highly intensive end-of-life care. However, specialist palliative care is associated with less aggressive interventions and increased deaths at home or in palliative care units. These findings underscore the need to strengthen and expand AYA-focused specialist palliative care to improve the quality of end-of-life care in this population. 

Click here to read this study in the CMAJ

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