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Jewitt N, Rapoport A, Gupta A, Srikanthan A, Sutradhar R, Luo J, Widger K, Wolfe J, Earle CC, Gupta S, Kassam A. The Effect of Specialized Palliative Care on End-of-Life Care Intensity in AYAs with Cancer. J Pain Symptom Manage 2023; 65:222-232. [PMID: 36423804 DOI: 10.1016/j.jpainsymman.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/01/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022]
Abstract
CONTEXT Many adolescents and young adults (AYAs; 15-39 years) with cancer receive high intensity (HI) care at the end of life (EOL). Palliative care (PC) involvement in this population is associated with lower risk of HI-EOL care. Whether this association differs by specialized vs. generalist PC (SPC, GPC) is unknown. OBJECTIVES (1) To evaluate whether SPC had an impact on the intensity of EOL care received by AYAs with cancer; (2) to determine which subpopulations are at highest risk for reduced access to SPC. METHODS A decedent cohort of AYAs with cancer who died between 2000-2017 in Ontario, Canada was identified using registry and population-based data. The primary composite measure of HI-EOL care included any of: intravenous chemotherapy <14 days from death; more than one ED visit, more than one hospitalization or any ICU admission <30 days from death. Physician's billing codes were used to define SPC and GPC involvement. RESULTS Of 7122 AYA decedents, 2140 (30%) received SPC and 943 (13%) received GPC. AYAs who died in earlier years, those with hematologic malignancies, males and rural AYAs were least likely to receive SPC. No PC involvement was associated with higher odds of receiving HI-EOL care (odds ratio (OR) 1.5; P < 0.0001). SPC involvement was associated with the lowest risk of HI-EOL care (OR SPC vs. GPC 0.8; P = 0.007) and decreased odds of ICU admission (OR 0.7; P = 0.006). CONCLUSION SPC involvement was associated with the lowest risk of HI-EOL care in AYAs with cancer. However, access to SPC remains a challenge.
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Affiliation(s)
- Natalie Jewitt
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada.
| | - Adam Rapoport
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Abha Gupta
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Amirrtha Srikanthan
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Rinku Sutradhar
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Jin Luo
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Kimberley Widger
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Joanne Wolfe
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Craig C Earle
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Sumit Gupta
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Alisha Kassam
- Paediatric Advanced Care Team (PACT) (N.J., A.R., K.W.), The Hospital for Sick Children, Toronto, Ontario, Canada; Faculty of Medicine (N.J., A.R., A.G., S.G., A.K.), University of Toronto, Toronto, Ontario, Canada; Emily's House Children's Hospice (A.R.), Toronto, Ontario, Canada; Division of Haematology/Oncology (A.G., S.G., A.K.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Oncology (A.S.), The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine (A.S.), University of Ottawa, Ottawa, Ontario, Canada; Cancer Research Program (R.S., J.L., C.E., S.G.), Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing (K.W.), University of Toronto, Toronto, Ontario, Canada; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (J.W.), Boston, Massachusetts; Department of Pediatrics (J.W.), Boston Children's Hospital, Boston, Massachusetts; Institute for Health Policy (S.G.), Evaluation and Management, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics and Division of Palliative Care (A.K.), Southlake Regional Health Centre, Newmarket, Ontario, Canada
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