Aims: To compare timing of referrals to palliative care services and institution of end-of-life care for older patients with advanced malignant and non-malignant conditions who have died during their hospital admission.
Methods: A retrospective observational study of patients aged ≥65 years who died at Western Health between 01/02/2022 and 21/11/2022 with a diagnosis of locally advanced and metastatic cancer versus common non-malignant conditions (heart failure, chronic lung diseases, end-stage renal failure and dementia). We compared time intervals between palliative care referral and commencement of end-of-life medications and death.
Results: The study included 404 patients divided into 3 groups [n=123 cancer (C), n=224 non-cancer (NC) and n=54 both (B)]. C patients were younger (mean 76.9 years) than NC and B patients (means 83.7 and 82.1 years respectively, p<0.0001). Heart failure was the most common non-malignant diagnosis (40.8%), and lung cancer was the most common malignancy (22.6%). NC patients were less likely to be referred to palliative care, 72.4% vs 97.4% with cancer vs 87% with both (p<0.0001). They also had a shorter interval between referral and death (median 2 vs 8 for cancer vs 3 days for both, p<0.0001). Subcutaneous end-of-life medications were started earlier before death in C and B patients, compared with NC patients, p<0.0001.
Conclusion: Our findings indicate that older patients with advanced non-malignant conditions are less likely to receive timely end-of-life care compared with older patients with cancer. Further research is required to understand the underlying reasons for this discrepancy.