Palliative care delivery according to age in 12,000 women with metastatic breast cancer: Analysis in the multicentre ESME-MBC cohort 2008-2016

Matthieu Frasca*, Camille Sabathe, Suzette Delaloge, Angeline Galvin, Anne Patsouris, Christelle Levy, Marie A Mouret-Reynier, Isabelle Desmoulins, Laurence Vanlemmens, Thomas Bachelot, Anthony Goncalves, Virginie Perotin, Lionel Uwer, Jean S Frenel, Jean M Ferrero, Carole Bouleuc, Jean C Eymard, Véronique Dieras, Marianne Leheurteur, Thierry PetitFlorence Dalenc, Anne Jaffre, Michaël Chevrot, Coralie Courtinard, Simone Mathoulin-Pelissier

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Introduction: Patients with metastatic breast cancer (MBC) often require inpatient palliative care (IPC). However, mounting evidence suggests age-related disparities in palliative care delivery. This study aimed to assess the cumulative incidence function (CIF) of IPC delivery, as well as the influence of age. Methods: The national ESME (Epidemio-Strategy-Medical-Economical)-MBC cohort includes consecutive MBC patients treated in 18 French Comprehensive Cancer Centres. ICD-10 palliative care coding was used for IPC identification. Results: Our analysis included 12,375 patients, 5093 (41.2%) of whom were aged 65 or over. The median follow-up was 41.5 months (95% confidence interval [CI], 40.5–42.5). The CIF of IPC was 10.3% (95% CI, 10.2–10.4) and 24.8% (95% CI, 24.7–24.8) at 2 and 8 years, respectively. At 2 years, among triple-negative patients, young patients (<65 yo) had a higher CIF of IPC than older patients after adjusting for cancer characteristics, centre and period (65+/<65: β = −0.05; 95% CI, −0.08 to −0.01). Among other tumour sub-types, older patients received short-term IPC more frequently than young patients (65+/<65: β = 0.02; 95% CI, 0.01 to 0.03). At 8 years, outside large centres, IPC was delivered less frequently to older patients adjusted to cancer characteristics and period (65+/<65: β = −0.03; 95% CI, −0.06 to −0.01). Conclusion: We found a relatively low CIF of IPC and that age influenced IPC delivery. Young triple-negative and older non-triple-negative patients needed more short-term IPCs. Older patients diagnosed outside large centres received less long-term IPC. These findings highlight the need for a wider implementation of IPC facilities and for more age-specific interventions.

Original languageEnglish
JournalEuropean journal of cancer (Oxford, England : 1990)
Volume137
Pages (from-to)240-249
Number of pages10
ISSN0959-8049
DOIs
Publication statusPublished - Sep 2020
Externally publishedYes

Keywords

  • Age
  • Inpatient care
  • Metastatic breast cancer
  • Palliative care
  • Palliative medicine

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