1594P - End-of-life hospital cancer care in the COVID-19 era: A retrospective population-based study in the Netherlands

Background

The COVID-19 pandemic impacted cancer diagnosis and treatment. However, little is known about end-of-life (EOL) cancer care during the pandemic. Therefore, the aim of this study was to investigate potentially inappropriate EOL hospital care in patients dying with cancer before and during the COVID-19 pandemic.

Methods

This population-based study used linked data from the Netherlands Cancer Registry and the Dutch National Hospital Care Registration. Patients deceased between January 2018 and May 2021, who were diagnosed with cancer or received hospital care for cancer in the year preceding death were included. Potentially inappropriate EOL care was compared between four periods during the COVID-19 pandemic and corresponding periods in 2018/2019. Six international indicators of potentially inappropriate care in the last month of life were used: chemotherapy administration, >1 emergency room contact, >1 hospitalization, hospitalization >14 days, intensive care unit admission and hospital death.

Results

In total, 112,919 patients were included. Less patients received potentially inappropriate EOL hospital care during the COVID-19 pandemic compared to the preceding years, most pronounced during the first COVID-19 peak (22,4% vs 26,0%). Regression analysis showed lower odds of potentially inappropriate EOL care during all COVID-19 periods (ranging between OR 0.81; 95%CI:0.74-0.88 and OR 0.92; 95%CI 0.87-0.97) after adjusting for age, gender and cancer type. For the separate indicators, less patients experienced multiple or long hospitalizations, intensive care unit admission or a hospital death during the pandemic.

Conclusions

Cancer patients experienced less potentially inappropriate EOL hospital care during the COVID-19 pandemic. Because lack of capacity, patients avoiding hospital and increased awareness for triaging and advance care planning (ACP) may all have contributed, it is unclear whether this reflects better quality care. Nevertheless, retaining awareness for triaging and ACP is important because it may help provide appropriate EOL care to an increasing number of patients in the context of limited resources.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

COVID and Cancer NL Consortium.

Funding

The Netherlands Organisation for Health Research and Development (ZonMW).

Disclosure

All authors have declared no conflicts of interest.