A Call to Action for Revisiting Goals of Care Discussions With Adolescents and Young Adults With Cancer

Menée aux Etats-Unis à partir de données de registres médicaux portant sur 1 929 adolescents ou jeunes adultes atteints d'un cancer de stade IV ou d'un cancer de stade I-III récidivant ou métastatique (âge : de 12 à 39 ans), cette étude examine les discussions documentées concernant les objectifs de soins (palliatifs, non palliatifs, non décidés, non discutés) dans les 90 derniers jours de vie

Résumé en anglais

In “Evolution in Documented Goals of Care at End of Life for Adolescents and Young Adults With Cancer,” Mastropolo et al addresses an important and understudied question regarding whether and how goals of care (GOC) change for adolescents and young adults (AYAs) with cancer as death approaches. To answer this question, the authors conducted a multisite, cross-sectional, retrospective study of nearly 2000 AYAs who died between 2003 and 2019 at 3 sites across 2 states. Eligible AYAs were aged 12 to 39 years at time of death with documentation of metastatic, relapsed, or refractory cancer. Standardized data abstraction algorithms were used to extract data from the electronic health record related to demographics, disease type, medical interventions, and documented conversations about GOC and treatment preferences. The study’s primary objective focused on assessing frequency, timing, and evolution of GOC discussions during the last 90 days of life; secondary objectives explored factors associated with earlier documentation of palliative goals as well as associations of GOC with medical interventions received. For purposes of analysis, timing of documented GOC was stratified as early (>60 days before death), middle (31-60 days before death), or late (≤30 days before death).