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Early referral to a palliative team improves end-of-life care among gynecological cancer patients: a retrospective, population-based study
  1. Torbjørn Paulsen1,2,
  2. Heidi Liland1,
  3. Tor Åge Myklebust2,3 and
  4. Kristina Lindemann1,4
  1. 1Department of Gynecological Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
  2. 2Department of Registration, Cancer Registry of Norway, Oslo, Norway
  3. 3Department of Research and Innovation, Møre og Romsdal Hospital Trust, Ålesund, Norway
  4. 4Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
  1. Correspondence to Dr Torbjørn Paulsen, Department of Gynecological Oncology, Division of Cancer Medicine, Oslo, Oslo University Hospital, Oslo, Norway; tpa{at}ous-hf.no

Abstract

Objective To assess end-of-life care among patients with gynecological cancer, and to describe the association between timing of palliative care referral and patterns of care.

Methods All women with residence in Oslo, Norway, who died of gynecological cancer between January 1, 2015 and December 30, 2017 (36 months), were identified. Patients were primarily treated at the Norwegian Radium Hospital and clinical data on end-of-life care were retrospectively extracted from the medical records.

Results We identified 163 patients with median age 70.1 years at death (range 26–100) with the following diagnoses: ovarian (n=100), uterine (n=40), cervical (n=21), and vulvar cancer (n=2). 53 (33%) of patients died in a palliative care unit, 34 patients (21%) died in nursing homes without palliative care, and 48 (29%) patients died in hospital. Only 15 (9%) patients died at home. 25 (15%) patients received chemotherapy in the last 30 days before death, especially ovarian cancer patients (n=21, 21%). 103 patients (61%) were referred to a palliative team prior to death. Referral to a palliative team was associated with a significantly reduced risk of intensive care unit admission (OR 0.11, 95% CI 0.02 to 0.62) and higher likelihood of a structured end-of-life discussion (OR 2.91, 95% CI 1.03 to 8.25). Palliative care referral also seemed to be associated with other quality indicators of end-of-life care (less chemotherapy use, more home deaths).

Conclusions End-of-life care in patients with gynecological cancer suffers from underuse of palliative care. Chemotherapy is still commonly used towards end-of-life. Early palliative care referral in the disease trajectory may be an important step towards improved end-of-life care.

  • palliative care
  • ovarian neoplasms
  • uterine cervical neoplasms
  • uterine neoplasms

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. On request an anonymous data file might be available by contacting the main author.

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Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. On request an anonymous data file might be available by contacting the main author.

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Footnotes

  • Collaborators Bård Kloppen, Marthe Sylten Engh, Martin Turzer.

  • Contributors The authors TP, HL, and KL have contributed with data collection from the medical records and writing the manuscript. TP, TÅM, and KL have contributed to the statistical analyses. All authors read and commented on the manuscript and approved the final version. TP is acting as guarantor and accepts full responsibility for the work and the conduct of the study. TP had access to the data, and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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