Palliative care (PC) is a part of a multidisciplinary approach that improves the quality of life of patients with potentially terminal illnesses including cancer. However, referrals to PC occur relatively late for the management of physical and psychological distress. In France, the proportion of patients who actually receive PC is not clear. This study aims to provide the prevalence and characteristics of dead cancer patients who have been referred at least one time to PC, and to identify the delay between PC access and death.
All people living in France (67 million population) with universal insurance coverage and diagnosed, treated or followed up for a cancer, such as survivors, are included and will be followed up for 25 years. Extracted from SNDS, the cancer cohort contains all healthcare consumption refunded data (i.e hospitalization, outpatient care, medication …) for subjects who have undergone cancer-related treatment since 2010. Every year, new cases are included in the cancer cohort. Data were extracted from the French “cancer cohort” databases for all people with cancer-related care between 2013 and 2015. Demographic characteristics, type of cancer, health care consumption, and delay between PC and death were determined.
Of the 310 901 cancer patients included in the Cancer Cohort in 2013, 70 858 (22.8%) died between 2013 and 2015. Of these, the proportion of PC access was 52%. Access to PC of dead cancer patients was different according to age, gender, type of cancer and comorbidities. The median time between diagnosis and death, diagnosis and PC access, and PC access and death, were 225.0 days (Q1-Q3: 84.0 - 418.0), 158.0 days (Q1-Q3: 38.0 - 354.0) and 26.0 days (Q1-Q3: 11.0 - 56.0), respectively.
If more than half of cancer patients in our study had access to PC before death, differences in age and gender were observed confirming the results of previous studies. We also noted that the delay between PC access and death indicates a late referral to PC in the disease trajectory. General practitioners, PC specialists and the community at large need education so that cancer patients have access to quality PC as soon as possible and without necessarily being in near end-of-life situations.
Clinical trial identification
Legal entity responsible for the study
French National Cancer Institute (INCa) - Cohort Cancer Group.
Has not received any funding.
All authors have declared no conflicts of interest.