A recent study published in the Canadian Medical Association Journal examines the challenges of providing palliative care to adolescents and young adults (AYAs) with cancer in Ontario. The research analyzed data from ICES, focusing on individuals aged 15 to 39 who died between January 1, 2018, and December 31, 2022. According to the study, more than half of these patients were female, with most falling into the oldest age group studied.
The study found that while access to palliative care has improved—76% of AYAs received such care during the last three months of life compared to only 43% in a previous period—significant obstacles remain. The authors state, "The integration of palliative care into standard cancer care, including for AYAs, remains challenging for various reasons, including the stigma around palliative care and the false belief among some patients and caregivers that palliative care is equivalent to end-of-life care and is associated with diminished hope."
Further findings show that AYAs received more intensive end-of-life interventions than adult cancer patients: one quarter had at least one emergency department visit in their final month; over half were admitted to hospital; and nearly a quarter required intensive care unit admission. The researchers note, "Our findings underscore that AYAs with cancer continue to receive higher-intensity end-of-life care than patients with cancer of all ages, despite having similar rates of palliative care involvement."
Patients seen by specialist palliative physicians within their last 90 days were more likely to die at home and less likely to die in an ICU compared to those who did not receive such specialized attention (41% vs. 12% at home; 12% vs. 38% in ICU). The authors conclude that "these findings indicate the need for a focus on the quality of palliative care provision for AYAs with cancer, and highlight the importance of developing a specialized AYA palliative care training framework for health care providers."
More details can be found in the full CMAJ article: https://www.cmaj.ca/lookup/doi/10.1503/cmaj.250615
