Quality of End-of-Life Care during the COVID-19 Pandemic at a Comprehensive Cancer Center

SIMPLE SUMMARY: To better understand how the COVID-19 pandemic impacted end-of-life care in patients with advanced cancer at a comprehensive cancer center, we compared in-hospital deaths from April through July 2019 with those from April through July 2020. After the onset of the pandemic, do-not-resuscitate orders occurred earlier, palliative care referrals occurred earlier, fewer deaths occurred in the Intensive Care Unit, and more deaths occurred in the Palliative Care Unit. These outcomes suggest an improvement in the quality of end-of-life care in response to the COVID-19 pandemic. These encouraging findings may have future implications for maintaining quality end-of-life care post-pandemic. ABSTRACT: To evaluate how the COVID-19 pandemic impacted the quality of end-of-life care for patients with advanced cancer, we compared a random sample of 250 inpatient deaths from 1 April 2019, to 31 July 2019, with 250 consecutive inpatient deaths from 1 April 2020, to 31 July 2020, at a comprehensive cancer center. Sociodemographic and clinical characteristics, the timing of palliative care referral, timing of do-not-resuscitate (DNR) orders, location of death, and pre-admission out-of-hospital DNR documentation were included. During the COVID-19 pandemic, DNR orders occurred earlier (2.9 vs. 1.7 days before death, p = 0.028), and palliative care referrals also occurred earlier (3.5 vs. 2.5 days before death, p = 0.041). During the pandemic, 36% of inpatient deaths occurred in the Intensive Care Unit (ICU) and 36% in the Palliative Care Unit, compared to 48 and 29%, respectively, before the pandemic (p = 0.001). Earlier DNR orders, earlier palliative care referrals, and fewer ICU deaths suggest an improvement in the quality of end-of-life care in response to the COVID-19 pandemic. These encouraging findings may have future implications for maintaining quality end-of-life care post-pandemic.