Originally published as JCO Early Release 10.1200/JCO.2004.06.111 on July 26 2004

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Pattern of Care at the End of Life: Does Age Make a Difference in What Happens to Women With Breast Cancer?

From Palliative Care Medicine, and the Cancer Nutrition and Rehabilitation Program, Department of Oncology, and the Department of Epidemiology and Biostatistics, McGill University; Division of Clinical Epidemiology, Royal Victoria Hospital; and McGill University Health Centre; Montreal, Canada

Address reprint requests to Bruno Gagnon, MD, MSc, Division of Clinical Epidemiology, Royal Victoria Hospital, 687 Pine Ave W, R.4.29, Montreal, Quebec H3A 1A1, Canada; e-mail: bruno.gagnon{at}clinepi.mcgill.ca

PURPOSE: In the last 40 years, palliative care has become the standard of care at the end of life. However, there are limited data about the degree of access to such care at the population level.

METHODS: Using administrative databases, a care-oriented profile score was created to describe the care received during the last 6 months of life for 2,291 women who were dying of breast cancer in the province of Quebec, Canada, during the years 1992 to 1998. The care received was described through indicators of care that would reflect a palliative care philosophy. An ordinal score was developed for comparisons among age groups of women using a proportional odds ordinal regression model.

RESULTS: We found that only 6.9% of women died at home, while 69.6% of them died in acute care beds. While most women (75%) had few indicators indicating provision of palliative care during the last 6 months of life, younger women (< 50 years) were even less likely (odds ratio, 0.70; 95% CI, 0.54 to 0.90) to receive such care compared with middle aged women (50 to 59 years; serving as the reference group), while older women (> 70 years) were more likely (odds ratio, 1.85; 95% CI, 1.49 to 2.29).

CONCLUSION: Our study indicates that a sizeable proportion of women terminally ill from breast cancer do not have access to palliative care—an issue that health care policy makers may wish to explore further.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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