More Than Two-thirds of Teen and Young Adult Cancer Patients Facing End of Life Use Aggressive Measures
July 09, 2015
Largest study of this
population suggests need for further research on helping them make informed
Public Radio and Forbes
are among the outlets that covered this study.
More than two-thirds of
adolescents and young adults dying of cancer utilized one or more aggressive
interventions in the last month of life, according to a retrospective study
from researchers at Dana-Farber/Boston Children’s Cancer and Blood
Disorders Center and Kaiser
Permanente Southern California. The results of the largest study to date of
this population, published today in JAMA Oncology, suggest the need for
more research into whether patients have been adequately supported to
contemplate their end-of-life options or whether the pattern reflects their
well-considered wishes, the authors note.
The researchers measured the
use of four aggressive measures – intensive care, emergency room, chemotherapy
and/or hospitalization – in the last month of life of 633 patients, age 15-39,
who died of cancer between 2001 and 2010. The patients, who received care at
Kaiser Permanente Southern California, had either been diagnosed with Stage IV
cancer or had a recurrence of cancer. An initial review of a subset of111
patients found that death had been anticipated in 98 percent of cases.
This study found that:
young patients were more than twice as likely as Medicare patients, age 65 and
older, to utilize intensive care and/or the emergency room in the last month of
life. Fewer than 10 percent of the older patients used these interventions,
compared with 22 percent of the adolescents and young adults.
of chemotherapy and hospitalization was similar in both age groups. Among the
younger patients, 11 percent received chemotherapy in the last two weeks of
life, and 62 percent were hospitalized in the last 30 days of life.
“A young person facing the
end of life is a particularly difficult issue,” said lead author Jennifer Mack, MD, MPH, a pediatric oncologist at Dana-Farber/Boston
Children’s and researcher in the Division of Population Sciences’ Center for
Outcomes and Policy Research at Dana-Farber Cancer Institute. “While use of aggressive measures might be an
informed decision by young people who would do anything they could to live
longer, some interventions come with a cost, which is a poorer quality of life.
This study raises questions about what kind of care they’re getting and how we
can get them to the best quality of life at the end of their lives.”
End-of-life care in
adolescents and young adults has not been well-studied. An earlier study
examined outcomes for 45 patients at a single French institution. Kaiser
Permanente Southern California is a managed care organization that serves an
ethnically, racially and economically diverse patient population of 3.7
“We should think about
talking with younger patients earlier about their prognoses, identifying their
preferences and working with them to deliver care that reflects those
preferences,” Mack said. “It may be that aggressive care is what they want, but
they may end up on this pathway without thoughtful conversation and maybe
without recognition that they are dying.”
Additional authors are Lie H.
Chen, DrPH, Kimberley Cannavale, MPH, Olivia Sattayapiwat, MPH, Robert M.
Cooper, MD, and Chun R. Chao, PhD, of Kaiser Permanente Southern California.
The study was funded by the Cancer Research Network/National Cancer Institute