End-of-Life Care Talks Occur Late for Young Cancer Patients

TOPLINE:

Palliative goals were frequently not documented until the last month of life in adolescents and younger adults who died of cancer. A new study found that documentation of palliative goals of care increased from 7.2% at 61-90 days before death to 57.7% in the final 30 days in this young patient population.

METHODOLOGY:

• Goals of care discussions are vital for patients with cancer, particularly young adults. However, for adolescents and young adults with advanced cancer, the evolution of care goals and how often these discussions happen remain unclear.
• This cross-sectional study included 1929 adolescents and young adults aged 12-39 years who died of cancer between January 2003 and December 2019 in the United States.
• Researchers analyzed the documented goals-of-care discussions during the last 90 days of life using medical record reviews from three healthcare institutions, with goals classified as palliative, nonpalliative, undecided, or not discussed.
• The timing of the documented goals of care was categorized into three periods: Initial (> 60 days before death), middle (31-60 days before death), and late (≤ 30 days before death), tracking the evolution of preferences over time.

TAKEAWAY:

• The documentation of palliative goals increased substantially over time, from 7.2% of patients in the initial period to 17.2% in the middle and 57.7% in the final period (P
• Racial disparities were evident, with Black and Hispanic or Latino patients having significantly higher rates of no documented discussions (19.1% and 22.6%, respectively) than White (14.1%) and non-Hispanic patients (12.2%).
• Compared with patients with solid tumors, those with hematologic cancers had higher rates of nonpalliative goal discussions (22.2% vs 33.2%).
• Compared with the younger group (

IN PRACTICE:

From this cross-sectional study of adolescents and younger adult patients who died of cancer, “palliative goals were rarely documented prior to the last month of life and were increasingly likely to be documented over time,” the authors wrote.

“Clinicians should lean into the discomfort of ambiguous or shifting [goals of care] and be sensitive about revisiting [goals of care] at the patient’s preferred pace,” Erica C. Kaye, MD, MPH, Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, said in an accompanying commentary.

SOURCE:

This study was led by Rosemarie Mastropolo, MD, Dana-Farber Cancer Institute, Boston, and was published online in JAMA Network Open, alongside an accompanying commentary.

LIMITATIONS:

This study relied on medical record documentation rather than patient reports, potentially missing undocumented conversations about goals of care. Documentation inconsistencies made it difficult to determine who participated in these conversations and whether the documented goals reflected patient or caregiver preferences.

DISCLOSURES:

This study received support through a grant from the National Cancer Institute and partial funding from the Intramural Program of the National Cancer Institute and the National Institutes of Health. Two authors reported receiving grants from the National Cancer Institute during the conduct of the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.