The impact of patient age on palliative care utilization and end-of-life outcomes among patients with metastatic breast cancer.

Abstract

12034 Background: Among patients with advanced cancer, palliative care (PC) utilization is frequently associated with improved quality of life, less aggressive end of life (EOL) measures, and hospice enrollment at the time of death. While older age is often associated with less PC utilization. The interplay between patient age, site and timing of PC with resultant EOL trends is not well understood. We aimed to assess these variations within a single institution’s metastatic breast cancer (mBC) population. Methods: An IRB approved retrospective study was conducted. All adult, decedent, mBC patients from 2011-2022 were analyzed. Manual chart review extracted demographic and clinical data related to diagnosis, treatment, PC utilization and death. The relationship of patient age with PC utilization (including setting and timing), aggressive EOL measures, hospice care at the time of death, and hospice duration were evaluated. Univariate analyses were conducted and factors with a significance level p < 0.15 were further evaluated on multivariable logistic regression. Results: 278 decedent mBC patients met inclusion criteria. Any form of PC interaction from date of metastatic diagnosis to date of death, and utilizing outpatient (OP) PC (i.e., only OP or OP + inpatient (IP)) during the last year of life were significantly associated with hospice enrollment at the time of death. Similarly, utilizing only OP PC (i.e., no IP) was significantly associated with a longer time on hospice care. There was a trend toward shorter hospice durations in mBC patients who received only IP PC, and patients who received any IP PC or had their first PC interaction < 4 months prior to the time of death were more likely to experience ≥ 1 aggressive EOL measure. Young adults (< 40) were significantly more likely to receive some form of PC throughout their disease course, with a trend toward receiving only IP PC. While no significant relationships were identified between age and EOL factors, there were trends toward young and middle-aged adults (40-64) receiving ≥ 1 aggressive EOL measure and less time on hospice compared to older adults (≥ 65). Conclusions: This study gives important insight into a breast cancer-specific female population. Results highlight the importance of PC, especially in the OP setting, and its effect on hospice enrollment prior to death. However, there appears to be an interesting dichotomy between young adults receiving more PC and worse EOL experiences compared to older adults receiving less PC and better EOL experiences. These results should guide and promote, early OP focused PC specifically for young and middle-aged adults to help improve challenging EOL transitions. [Table: see text]