Pattern of care at the end of life: does age make a difference in what happens to women with breast cancer?
OBJECTIVE
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).


CONCLUSIONS
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.
Department of Oncology, McGill University, Montreal, Quebec, Canada. bruno.gagnon@clinepi.mcgill.ca
Bruno
B
Gagnon
Nancy E
NE
Mayo
James
J
Hanley
Neil
N
MacDonald
D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000628:therapy*; D002170:Canada; D015331:Cohort Studies; D005260:Female; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D010166:Palliative Care; D011787:Quality of Health Care