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Cancer and end of life: the management provided during the year and the month preceding death in 2015 and causes of death in France

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Abstract

Purpose

The management of cancer patients at the end of life in France and their causes of death are not well known.

Methods

People managed for cancer in 2014–2015, who died in 2015 and who were covered by the national health insurance general scheme (77% of the French population) were selected from the national health data system in order to analyze the health care reimbursed during the year and the month before their death.

Results

This study included 125,497 people (mean age 73 years, SD 12.5) managed for cancer: colorectal: 12%, lung: 18%, prostate: 9%, breast: 8% and other: 62%. Almost 67% of people died in short-stay hospitals (SSH), 8% died in rehabilitation units (Rehab), 4% died in hospital at home (HaH), 5% died in skilled nursing homes (SNH) and 15% died at home or another place. The mean annual duration of all types of hospitalization was 70 days (SD 66) and 59% of patients had received hospital palliative care (HPC). During the last month of life, 42% of people had attended an emergency department at least once and people who had received HPC were less often admitted to an intensive care unit (10% versus 23%, 15% overall). During the month before death, 17% of patients had received intravenous chemotherapy (lung 23%, breast 21%) and 9% had received a pharmacy reimbursement for another form of chemotherapy (prostate 24%, breast 19%). The main cause of death was a tumour for 81% of patients: after management of lung cancer in 91% of cases, breast cancer in 81% of cases, colorectal cancer in 76% of cases and prostate cancer in 63% of cases.

Conclusions

Cancer management and death mostly occurred in SSH in France. Cancer patients frequently attend the emergency department and frequently receive chemotherapy during the last month of life. These data continue to contrast with those observed in Scandinavian- and English-speaking countries, in which management of the end of life at home is preferred.

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Abbreviations

Cnam:

Caisse Nationale d’Assurance Maladie (general health scheme fund)

HaH:

hospital at home

HPC:

hospital palliative care

Rehab:

rehabilitation units

SD:

standard deviation

SNDS:

National Health Data System

SNH:

skilled nursing homes

SSH:

short-stay hospitals

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Acknowledgements

The authors would like to thank the members of the Centre national de la fin de vie et des soins palliatifs, especially Dr. V. Fournier and S. Bretonnière, for their participation, as well as Prof. R. Aubry and Dr. Russo.

Funding

Self-funded by CNAM.

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Authors

Corresponding author

Correspondence to Philippe Tuppin.

Ethics declarations

This study was based on an administrative database (SNDS) used for reimbursement. Analyses of SNDS data by CNAM were performed with the permission of the CNIL (French data protection authority) and by decree.

Conflict of interest

The authors declare that they have no competing interest.

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Melac, A.T., Lesuffleur, T., Bousquet, PJ. et al. Cancer and end of life: the management provided during the year and the month preceding death in 2015 and causes of death in France. Support Care Cancer 28, 3877–3887 (2020). https://doi.org/10.1007/s00520-019-05188-z

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  • DOI: https://doi.org/10.1007/s00520-019-05188-z

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