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. 2023 Jun 26;15(13):3349.
doi: 10.3390/cancers15133349.

End-of-Life Care in the Last Three Months before Death in Older Patients with Cancer in Belgium: A Large Retrospective Cohort Study Using Data Linkage

Victoria Depoorter  1 , Katrijn Vanschoenbeek  2 , Lore Decoster  3 , Geert Silversmit  2 , Philip R Debruyne  4   5   6 , Inge De Groof  7 , Dominique Bron  8 , Frank Cornélis  9 , Sylvie Luce  10 , Christian Focan  11 , Vincent Verschaeve  12 , Gwenaëlle Debugne  13 , Christine Langenaeken  14 , Heidi Van Den Bulck  15 , Jean-Charles Goeminne  16 , Wesley Teurfs  17 , Guy Jerusalem  18 , Dirk Schrijvers  19 , Bénédicte Petit  20 , Marika Rasschaert  21 , Jean-Philippe Praet  22 , Katherine Vandenborre  23 , Harlinde De Schutter  2 , Koen Milisen  24   25 , Johan Flamaing  25   26 , Cindy Kenis  24   25   27 , Freija Verdoodt  2 , Hans Wildiers  1   27
Affiliations

End-of-Life Care in the Last Three Months before Death in Older Patients with Cancer in Belgium: A Large Retrospective Cohort Study Using Data Linkage

Victoria Depoorter et al. Cancers (Basel). .

Abstract

This study aims to describe end-of-life (EOL) care in older patients with cancer and investigate the association between geriatric assessment (GA) results and specialized palliative care (SPC) use. Older patients with a new cancer diagnosis (2009-2015) originally included in a previous multicentric study were selected if they died before the end of follow-up (2019). At the time of cancer diagnosis, patients underwent geriatric screening with Geriatric 8 (G8) followed by GA in case of a G8 score ≤14/17. These data were linked to the cancer registry and healthcare reimbursement data for follow-up. EOL care was assessed in the last three months before death, and associations were analyzed using logistic regression. A total of 3546 deceased older patients with cancer with a median age of 79 years at diagnosis were included. Breast, colon, and lung cancer were the most common diagnoses. In the last three months of life, 76.3% were hospitalized, 49.1% had an emergency department visit, and 43.5% received SPC. In total, 55.0% died in the hospital (38.5% in a non-palliative care unit and 16.4% in a palliative care unit). In multivariable analyses, functional and cognitive impairment at cancer diagnosis was associated with less SPC. Further research on optimizing EOL healthcare utilization and broadening access to SPC is needed.

Keywords: geriatric oncology; population-based data; specialized palliative care; terminal healthcare utilization.

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Conflict of interest statement

L.D.’s institution received a research grant from Boehringer Ingelheim; consulting fees from Roche; lecture fees from Roche, BMS, MSD, Servier, and Sanofi; travel support from Roche, Astra-Zeneca, and MSD; and advisory board fees from MSD, BMS, and Astra-Zeneca. P.R.D.’s institution received a research grant from Pfizer. P.R.D. received consulting fees from Bristol-Myers Squibb, Merck/Pfizer, and Ipsen; lecture fee from Bayer; travel support from Janssen; and owns stock in Alkermes and Biocartis Group. V.V. received lecture fees from Institut Bordet, and MSD; travel support from Ipsen, and Janssen; and advisory board fees from Janssen, Astellas, and MSD. G.J.’s institution received research grants from Novartis, Roche, and Pfizer. G.J. received consulting fees, lecture fees, travel support and/or advisory board fees from Novartis, Amgen, Roche, Pfizer, Bristol-Myers Squibb, Eli Lilly, Astra-Zeneca, Daiichi Sankyo, Abbvie, Seagen, Medimmune, Merck, and Diaccurate. J.F.’s institution received advisory board fees and/or lecture fees from Pfizer, GSK, Merck, and Janssen. H.W.’s institution received research grants from Roche, Novartis, and Gilead; and received consulting fees, lecture fees and/or travel support from Abbvie, Daiichi, Gilead, Eli Lilly, Pfizer, Astra-Zeneca, EISAI, Immutep Pty, MSD, Astra-Zeneca Ireland, and Relay Therapeutics. All other authors declare no competing interest. The funders had no role in the study’s design; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Patient Flow Chart. (Abbreviations: y, years; GS, geriatric screening; GA, geriatric assessment; BCR, Belgian Cancer Registry; IMA, InterMutualistic Agency; m, months; G8: Geriatric 8).
Figure 2
Figure 2
Healthcare utilization at the end of life in older patients with cancer: percentage of patients with use/contacts per 10-day interval in the last three months (n = 3546).
Figure 3
Figure 3
Hospital palliative care and palliative home care use at the end of life in older patients with cancer: percentage of patients with use/contacts (n = 3546).
Figure 4
Figure 4
Specialized palliative care use in the last three months before death in older patients with cancer (n = 3546). (Mobile palliative care teams in hospitals or nursing homes cannot be distinguished in administrative data and are not reported, potentially leading to an underestimation of the percentage of patients receiving palliative care).
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