The following is a summary of “Effect of Specialized Palliative Care on End-of-Life Care Intensity in AYAs with Cancer,” published in the MARCH 2023 issue of Pain Management by Jewitt, et al.

In a study conducted in Ontario, Canada, it was found that many adolescents and young adults (AYAs) with cancer received high-intensity care at the end of life (EOL). However, palliative care (PC) involvement was associated with a lower risk of high-intensity EOL care. It was unclear whether this association differed by specialized vs. generalist PC (SPC, GPC).

For a study, researchers sought to evaluate whether specialized PC had an impact on the intensity of EOL care received by AYAs with cancer and to determine which subpopulations are at the highest risk for reduced access to specialized PC. They identified a cohort of AYAs with cancer who died between 2000-2017 using registry and population-based data. The main composite measure of HI-EOL care comprised any occurrence of IV chemotherapy <14 days of mortality, as well as multiple ED visits, hospital stays, or ICU admissions <30 days of death. Physician billing codes were used to define specialized and generalist PC involvement.

Out of 7,122 AYA decedents, 2,140 (30%) received specialized PC and 943 (13%) received generalist PC. AYAs who died in earlier years, those with hematologic malignancies, males, and rural AYAs were least likely to receive specialized PC. No PC involvement was associated with higher odds of receiving high-intensity EOL care (odds ratio (OR) 1.5; P < 0.0001). Specialized PC involvement was associated with the lowest risk of high-intensity EOL care (OR SPC vs. GPC 0.8; P = 0.007) and decreased odds of ICU admission (OR 0.7; P = 0.006).

In conclusion, specialized PC involvement was associated with the lowest risk of high-intensity EOL care in AYAs with cancer. However, the study found that access to specialized PC remains a challenge, particularly for certain subpopulations.

Reference: jpsmjournal.com/article/S0885-3924(22)00977-0/fulltext