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

• Published in: Clinical epidemiology Vol. 11; no. 4; pp. 443 - 455
• Main Authors: Janah, Asmaa, Gauthier, Lynn R, Morin, Lucas, Bousquet, Philippe Jean, Le Bihan, Christine, Tuppin, Philippe, Peretti-Watel, Patrick, Bendiane, Marc-Karim
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.06.2019; Dove Medical Press; Dove
• Subjects: Analysis; Breast Neoplasms; cancer; Cancer diagnosis; Cancer metastasis; Cancer patients; Cancer research; Care and treatment; Communication; Cross-Sectional Studies; death; Diabetes Mellitus; factors; Female; French national health system database; Humanities and Social Sciences; Humans; Longitudinal Studies; Medicin och hälsovetenskap; Middle Aged; Original Research; Palliative care; Reproducibility of Results; Sexual Behavior; Sexuality; Statistics; Surveys and Questionnaires; timing; France; cancer; death; palliative care; timing; French national health system database; factors; communication about sexuality; sexual quality of life; oncosexology; supportive care in cancer; VICAN survey; breast cancer
• ISSN: 1179-1349; 1179-1349
• DOI: 10.2147/CLEP.S198499

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. 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. 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. 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.