Goals of Care at End of Life for Adolescents and Younger Adults With Cancer
Author Information
Author(s): Mastropolo Rosemarie MD, Cernik Colin MS, Uno Hajime PhD, Fisher Lauren MPH, Xu Lanfang MS, Laurent Cecile A. MS, Cannizzaro Nancy BA, Munneke Julie BA, Cooper Robert M. MD, Lakin Joshua R. MD, Schwartz Corey M. MD, Casperson Mallory MS, Altschuler Andrea PhD, Kushi Lawrence ScD, Chao Chun R. PhD, Wiener Lori PhD, Mack Jennifer W. MD MPH
Primary Institution: Dana-Farber Cancer Institute
Hypothesis
How do the goals of care evolve for adolescents and younger adult (AYA) patients 12 through 39 years of age with cancer in the last 90 days of life?
Conclusion
Palliative goals were rarely documented before the last month of life, highlighting the need for timely and ongoing goals of care discussions.
Supporting Evidence
- Documented palliative goals of care increased from 7.2% to 57.7% as patients approached death.
- 20.4% of patients transitioned from nonpalliative to palliative goals before death.
- Many patients had no documented goals of care discussions until close to death.
Takeaway
This study looked at how young cancer patients' care goals change as they get closer to death, finding that many don't talk about palliative care until it's almost too late.
Methodology
This cross-sectional study included a retrospective review of medical records from AYA patients with cancer who died between 2003 and 2019.
Potential Biases
Black and Hispanic patients were more likely to lack documented goals of care discussions compared to White patients.
Limitations
The study relied on medical record documentation of goals of care rather than patient reports, which may not capture all discussions.
Participant Demographics
The mean age at cancer diagnosis was 28 years, with 54.5% female and diverse racial and ethnic backgrounds.
Statistical Information
P-Value
p<0.001
Statistical Significance
p<0.001
Digital Object Identifier (DOI)
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