- Chris Schilling, Olivia Wawryk, Anna Collins, Vijaya Sundararajan, Brian H. Le, Jennifer Philip
Correspondence: chris.schilling@unimelb.edu.au
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Abstract
Objectives
To determine how many people who die of cancer in Victoria receive palliative care and early palliative care (more than 3 months before death); to assess the impact of early palliative care on the quality of end-of-life care.
Study Design
Retrospective, population-based cohort study; analysis of linked Victorian Cancer Registry data and routinely collected data for inpatient, non-admitted health service and emergency department care during the 12 months prior to death.
Setting, Participants
Victorian adults who died of cancer during 1 January 2018–31 January 2023.
Main Outcome Measures
Proportions of people who received palliative care (any time) or early palliative care (more than 3 months prior to death); likelihood of quality of end-of-life care measures: dying outside an acute hospital; chemotherapy, two or more emergency department visits, two or more hospital admissions during final 30 days of life; advance care plan at death.
Results
Of 53,305 people who died of cancer (mean age, 74.8 years [standard deviation, 13.0 years]; 29,527 men [55.4%]), palliative care was provided for 38,697 (72.6%); 17,409 people (32.7%) received early palliative care. The most frequent palliative care type was palliative approach to care (Z51.5 code; 33,974 people, 63.7%). The overall proportion of people who received palliative care did not change markedly during 2018–2022; the proportion who received early palliative care declined slightly, from 34.8% (95% confidence interval [CI], 33.6–35.9) to 33.0% (95% CI, 31.7–33.8). People who received early palliative care were more likely than people who received late palliative care to have an advance care plan (adjusted odds ratio [aOR], 1.46; 95% CI, 1.38–1.55) and to die outside hospital (aOR, 2.50; 95% CI, 2.37–2.64); they were less likely to have two or more of emergency department presentations (aOR, 0.75; 95% CI, 0.70–0.81), two or more hospital admissions (aOR, 0.58; 95% CI, 0.55–0.61) or chemotherapy (aOR, 0.51; 95% CI, 0.47–0.55) during their final 30 days of life.
Conclusion
72.6% of people who died of cancer in Victoria during 2018–2023 had received palliative care, but only 33% had received it early. End-of-life care may be improved by providing palliative care early. The low early palliative care rate, despite the potential for improved outcomes for people who receive it, indicates that action is needed.