End-of-life care for teens and young adults with cancer studied

Among teens and young adults age 15 to 39 years with terminal cancer, 11% 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 intensive care unit. These findings were published in JAMA Oncology (2015; doi:10.1001/jamaoncol.2015.1953).

Further, 22% of patients (147 of 663) had more than one emergency department visit, and 62% of patients (413 of 663) were hospitalized. Overall, 68% of patients (449 of 663) received at least one medically intensive end-of-life care measure.

In this study, corresponding author Jennifer W. Mack, MD, MPH, of the Dana-Farber Cancer Institute in Boston, Massachusetts, and her coauthors looked at the intensity of end-of-life care for teens and young adults who died between the ages of 15 and 39 years. The study analyzed the Kaiser Permanente Southern California cancer registry data and electronic health records for 663 adolescents and young adults with stage 1 to 3 cancer and evidence of cancer recurrence or stage 4 cancer at diagnosis. All patients died between 2001 and 2010.

The most common cancer diagnosis was gastrointestinal cancer, while other common diagnoses were breast cancer, genitourinary cancers, leukemia, and lymphoma.

The authors noted that their findings may not reflect care for the wider U.S. population.

 “Although adult patients who know they are dying usually do not want to receive aggressive care, which is associated with poorer quality of life near death, we do not know whether [adolescents and young adults] feel the same way,” the authors wrote.

“High rates of intensive end-of-life (EOL) measures in this population may not be a failure of communication or palliative care but might reflect very different values for EOL care in these young people compared with older adults. … However, our data provide a starting point for understanding patterns of care and ultimately defining optimal EOL care in this young population. Ongoing work should focus on understanding EOL care needs and preferences.”

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