Palliative care involvement and intensity of end-of-life care among adolescents and young adults with cancer: a population-based study.
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BACKGROUND: Adolescents and young adults (AYAs) with cancer often experience high-intensity end-of-life care and low utilization of palliative care. To explore this further, we evaluated the frequency of palliative care involvement and its association with end-of-life care intensity among AYAs with cancer in Ontario, Canada. METHODS: We conducted a retrospective cohort study using health administrative databases in Ontario, Canada, from Jan. 1, 2018, to Dec. 31, 2022. The cohort included AYA cancer decedents, aged 15 to 39 years. We categorized palliative care involvement into lifetime involvement and involvement in the last 90 days of life. We classified palliative care according to whether it was provided by a generalist or specialist physician using previously validated criteria. The primary outcome was the prevalence of palliative care involvement. Secondary outcomes included various measures of the intensity of end-of-life care; we analyzed whether palliative care involvement was associated with intensity of end-of-life care. RESULTS: Among 1981 AYAs, 76% had palliative care involvement in the last 90 days of life, of which 89% were from specialist palliative care physicians. Specialist palliative care involvement was associated with higher rates of hospital admission (58% v. 57% v. 47%, p = 0.0004), but lower use of mechanical ventilation (12% v. 36% v. 33%, p < 0.0001), hospital deaths (42% v. 64% v. 56%, p < 0.0001), and intensive care unit deaths (12% v. 38% v. 38%, p < 0.0001) compared with generalist and no palliative care, respectively. INTERPRETATION: Both palliative care and intensive care are increasingly used among AYAs with cancer at the end of life in Ontario, Canada. Increasing the availability of specialized AYA-focused palliative care may help to optimize end-of-life care in this population.