End-of-Life Care in the Last Three Months before Death in Older Patients with Cancer in Belgium: A Large Retrospective Cohort Study Using Data Linkage

SIMPLE SUMMARY: The care older patients with cancer receive in Belgium in the last months of life is not well defined. This study aimed to describe healthcare use at the end of life and explore which factors are associated with palliative care. This study shows that older patients with cancer in Belgium have frequent hospital admissions and emergency department visits before death and that more than half of the patients die in the hospital. Furthermore, we demonstrated that patients with limitations in function and cognition at cancer diagnosis receive less palliative care. This study gives insights into the type of care older patients depend on before death and which older patients receive less palliative care. Ultimately, healthcare use in the end-of-life period should be optimized, and palliative care should be made equally available in older patients with cancer. ABSTRACT: This study aims to describe end-of-life (EOL) care in older patients with cancer and investigate the association between geriatric assessment (GA) results and specialized palliative care (SPC) use. Older patients with a new cancer diagnosis (2009–2015) originally included in a previous multicentric study were selected if they died before the end of follow-up (2019). At the time of cancer diagnosis, patients underwent geriatric screening with Geriatric 8 (G8) followed by GA in case of a G8 score ≤14/17. These data were linked to the cancer registry and healthcare reimbursement data for follow-up. EOL care was assessed in the last three months before death, and associations were analyzed using logistic regression. A total of 3546 deceased older patients with cancer with a median age of 79 years at diagnosis were included. Breast, colon, and lung cancer were the most common diagnoses. In the last three months of life, 76.3% were hospitalized, 49.1% had an emergency department visit, and 43.5% received SPC. In total, 55.0% died in the hospital (38.5% in a non-palliative care unit and 16.4% in a palliative care unit). In multivariable analyses, functional and cognitive impairment at cancer diagnosis was associated with less SPC. Further research on optimizing EOL healthcare utilization and broadening access to SPC is needed.