Hospital-based Palliative Care Referrals: Determinants in Older Adults with Cancer

Overview

Journal BMJ Support Palliat Care

Publisher BMJ Publishing Group

Specialties Critical Care
Pharmacology
Psychiatry

Date 2024 Feb 20

PMID 38378243

Authors

Alex Chanteclair

Sophie Duc

Brice Amadeo

Gaelle Coureau

Pierre Soubeyran

Simone Mathoulin-Pelissier

Karine Peres

Catherine Helmer

Angeline Galvin

Matthieu Frasca

Affiliations

Soon will be listed here.

Abstract

Objectives: Early palliative care improves the quality of life of older patients with cancer. This work aimed to analyse the effect of sociodemographic, geriatric, and tumour-related determinants on hospital-based palliative care (HPC) referral in older patients with cancer, taking into account competing risk of death.

Methods: Older adults with diagnosed cancer from 2014 to 2018 according to the general cancer registry of Gironde (French department) were identified in three population-based cohorts on ageing (PAQUID, 3C - Three City, AMI). Cause-specific Cox models focused on 10 usual determinants in geriatric oncology and palliative care: age, gender, living alone, place of residency, tumour prognosis, activities of daily living (ADL) and instrumental-ADL (IADL) limitations, cognitive impairment, depressive disorders, and polypharmacy.

Results: 131 patients with incident cancer (mean age: 86.2 years, men: 62.6%, poor cancer prognosis: 32.8%) were included, HPC occurring for 26 of them. Unfavourable cancer prognosis was a key determinant for HPC referral (HR 7.02, 95% CI 2.86 to 17.23). An altered IADL score was associated with precocious (first year) referral (HR 3.21, 95% CI 1.20 to 8.64, respectively). Women had a higher rate immediately (first week) after diagnosis (HR 8.64, 95% CI 1.27 to 87.27).

Conclusions: Cancer prognosis, functional decline and gender are independent factors of HPC referral in older patients with cancer. These findings may help for a better anticipation of the healthcare pathway.

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