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

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FRASCA, Matthieu | SABATHE, Camille | DELALOGE, Suzette | GALVIN, Angeline | PATSOURIS, Anne | LEVY, Christelle | MOURET-REYNIER, Marie A. | DESMOULINS, Isabelle | VANLEMMENS, Laurence | BACHELOT, Thomas | GONCALVES, Anthony | PEROTIN, Virginie | UWER, Lionel | FRENEL, Jean S. | FERRERO, Jean M. | BOULEUC, Carole | EYMARD, Jean C. | DIERAS, Véronique | LEHEURTEUR, Marianne | PETIT, Thierry | DALENC, Florence | JAFFRE, Anne | CHEVROT, Michaël | COURTINARD, Coralie | MATHOULIN-PELISSIER, Simone

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: ß = -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: ß = 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: ß = -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.

http://dx.doi.org/10.1016/j.ejca.2020.07.007

Voir la revue «EUROPEAN JOURNAL OF CANCER, 137»

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