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. 2015 Aug;1(5):592-600.
doi: 10.1001/jamaoncol.2015.1953.

End-of-Life Care Intensity Among Adolescent and Young Adult Patients With Cancer in Kaiser Permanente Southern California

Jennifer W Mack  1 , Lie H Chen  2 , Kimberley Cannavale  3 , Olivia Sattayapiwat  3 , Robert M Cooper  4 , Chun R Chao  2
Affiliations

End-of-Life Care Intensity Among Adolescent and Young Adult Patients With Cancer in Kaiser Permanente Southern California

Jennifer W Mack et al. JAMA Oncol. 2015 Aug.

Abstract

Importance: Cancer is the leading disease-related cause of death among adolescents and young adults (AYAs), but little is known about the care that AYA patients with cancer receive at the end of life (EOL).

Objective: To evaluate the intensity of EOL care among AYA patients with cancer.

Design, setting, and participants: Cross-sectional study of Kaiser Permanente Southern California (KSPC) cancer registry data and electronic health records for 663 AYA patients with either stage I to III cancer and evidence of cancer recurrence or stage IV cancer at diagnosis. All patients were treated within KSPC, an integrated health care delivery system, and died between 2001 and 2010 before age 40 years (age range at time of death, 15-39 years).

Main outcomes and measures: (1) Chemotherapy use in the last 14 days of life; (2) intensive care unit (ICU) care in the last 30 days of life; (3) more than 1 emergency department (ED) visit in the last 30 days of life; (4) hospitalization in the last 30 days of life; and (5) a composite measure of medically intensive EOL care including any of the aforementioned measures.

Results: Eleven percent of patients (72 of 663) received chemotherapy within 14 days of death. In the last 30 days of life, 22% of patients (144 of 663) were admitted to the ICU; 22% (147 of 663) had more than 1 ED visit; and 62% (413 of 663) were hospitalized. Overall, 68% of patients (449 of 663) received at least 1 medically intensive EOL care measure.

Conclusions and relevance: Most AYA patients received at least 1 form of medically intensive EOL care. These findings suggest the need to better understand EOL care preferences and decision making in this young population.

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Conflict of interest statement

All conflict of interest disclosure information for all authors is accurate, complete, and up-to-date.

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References

    1. Wein S, Pery S, Zer A. Role of palliative care in adolescent and young adult oncology. J Clin Oncol. 2010;28(32):4819–4824. - PubMed
    1. Zebrack B, Mathews-Bradshaw B, Siegel S. Quality cancer care for adolescents and young adults: a position statement. J Clin Oncol. 2010;28(32):4862–4867. - PubMed
    1. Walter JK, Rosenberg AR, Feudtner C. Tackling taboo topics: how to have effective advanced care planning discussions with adolescents and young adults with cancer. JAMA Pediatr. 2013;167(5):489–490. - PubMed
    1. Coccia PF, et al. Adolescent and young adult oncology. Clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2012;10(9):1112–1150. - PubMed
    1. Wiener L, et al. Allowing adolescents and young adults to plan their end-of-life care. Pediatrics. 2012;130(5):897–905. - PMC - PubMed

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