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End‐of‐life care for hospitalized patients with metastatic melanoma in France: a nationwide, register‐based study
Author(s) -
Gallais Sérézal I.,
Beaussant Y.,
Rochigneux P.,
Tournigand C.,
Aubry R.,
Lindelöf B.,
Morin L.
Publication year - 2016
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.14631
Subject(s) - medicine , referral , palliative care , cancer , quality of life (healthcare) , melanoma , radiation therapy , end of life care , emergency medicine , pediatrics , family medicine , nursing , cancer research
Summary Background Although the aggressiveness of end‐of‐life cancer care has come under great scrutiny over the past two decades, little is known about the intensity of care and treatments in the last months of life of patients with metastatic melanoma. Objectives To measure the prevalence of aggressive cancer care use, and to assess the frequency of palliative care referral over the course of the last 3 months of life of hospitalized patients who died from metastatic melanoma. Methods A nationwide register‐based study in France was carried out, including all hospitalized adults aged ≥ 20 years who died from metastatic melanoma in metropolitan France between 2010 and 2013. Results Of 3889 patients who died from metastatic melanoma, 51·9% received chemotherapy in the last 3 months before death, 25·9% in the last month, 12·9% in the last 2 weeks and 7·6% in the last week. On average, patients were hospitalized for 31·7 days over the course of their last 3 months of life. During the final month before death, 12·0% of patients received radiation therapy, 14·0% received blood transfusion, 12·1% were transferred into an intensive care unit and 19·7% remained hospitalized continuously. Palliative care needs were identified in 78·4% of patients, with variations according to the type of facility. In total 17% of all patients died in palliative care inpatient units. Conclusions Treatment intensity near the end of life of patients with metastatic melanoma raises concerns for the quality of care. There is a need for clinical guidelines and adequate support to facilitate patient–physician communication and to improve access to palliative care services.