• Ellis Slotman, Heidi P Fransen, Hanneke Wm van Laarhoven, Marieke Hj van den Beuken-van Everdingen, Vivianne Cg Tjan-Heijnen, Auke Mt Huijben, Agnes Jager, Lia van Zuylen, Evelien Jm Kuip, Yvette M van der Linden, Natasja Jh Raijmakers, and Sabine Siesling.
• Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
• Palliat Med. 2024 Jan 1; 38 (1): 140149140-149.

BackgroundThe COVID-19 pandemic impacted cancer diagnosis and treatment. However, little is known about end-of-life cancer care during the pandemic.AimTo investigate potentially inappropriate end-of-life hospital care for cancer patients before and during the COVID-19 pandemic.DesignRetrospective population-based cohort study using data from the Netherlands Cancer Registry and the Dutch National Hospital Care Registration. Potentially inappropriate care in the last month of life (chemotherapy administration, >1 emergency room contact, >1 hospitalization, hospitalization >14 days, intensive care unit admission or hospital death) was compared between four COVID-19 periods and corresponding periods in 2018/2019.ParticipantsA total of 112,919 cancer patients (⩾18 years) who died between January 2018 and May 2021 were included.ResultsFewer patients received potentially inappropriate end-of-life care during the COVID-19 pandemic compared to previous years, especially during the first COVID-19 peak (22.4% vs 26.0%). Regression analysis showed lower odds of potentially inappropriate end-of-life care during all COVID-19 periods (between OR 0.81; 95% CI 0.74-0.88 and OR 0.92; 95% CI 0.87-0.97) after adjustment for age, sex and cancer type. For the individual indicators, fewer patients experienced multiple or long hospitalizations, intensive care unit admission or hospital death during the pandemic.ConclusionsCancer patients received less potentially inappropriate end-of-life care during the COVID-19 pandemic. Because several factors may have contributed, it is unclear whether this reflects better quality care. However, these findings raise important questions about what pandemic-induced changes in care practices can help provide appropriate end-of-life care for future patients in the context of increasing patient numbers and limited resources.

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