Reduction in potentially inappropriate end-of-life hospital care for cancer patients during the COVID-19 pandemic: A retrospective population-based study
Ellis Slotman, Heidi P Fransen, Hanneke WM van Laarhoven, Marieke HJ van den Beuken-van Everdingen, Vivianne CG Tjan-Heijnen, Auke MT Huijben, Agnes Jager, Lia van Zuylen, Evelien JM Kuip, Yvette M van der Linden, Natasja JH Raijmakers, Sabine Siesling- Anesthesiology and Pain Medicine
- General Medicine
Background:
The COVID-19 pandemic impacted cancer diagnosis and treatment. However, little is known about end-of-life cancer care during the pandemic.
Aim:
To investigate potentially inappropriate end-of-life hospital care for cancer patients before and during the COVID-19 pandemic.
Design:
Retrospective population-based cohort study using data from the Netherlands Cancer Registry and the Dutch National Hospital Care Registration. Potentially inappropriate care in the last month of life (chemotherapy administration, >1 emergency room contact, >1 hospitalization, hospitalization >14 days, intensive care unit admission or hospital death) was compared between four COVID-19 periods and corresponding periods in 2018/2019.
Participants:
A total of 112,919 cancer patients (⩾18 years) who died between January 2018 and May 2021 were included.
Results:
Fewer patients received potentially inappropriate end-of-life care during the COVID-19 pandemic compared to previous years, especially during the first COVID-19 peak (22.4% vs 26.0%). Regression analysis showed lower odds of potentially inappropriate end-of-life care during all COVID-19 periods (between OR 0.81; 95% CI 0.74–0.88 and OR 0.92; 95% CI 0.87–0.97) after adjustment for age, sex and cancer type. For the individual indicators, fewer patients experienced multiple or long hospitalizations, intensive care unit admission or hospital death during the pandemic.
Conclusions:
Cancer patients received less potentially inappropriate end-of-life care during the COVID-19 pandemic. Because several factors may have contributed, it is unclear whether this reflects better quality care. However, these findings raise important questions about what pandemic-induced changes in care practices can help provide appropriate end-of-life care for future patients in the context of increasing patient numbers and limited resources.