title: End-of-Life Care Intensity Among Adolescent and Young Adult Patients With Cancer in Kaiser Permanente Southern California.
abstract: OBJECTIVE
  Cancer is the leading disease-related cause of death among adolescents and young adults (AYAs), but little is known about the care that AYA patients with cancer receive at the end of life (EOL).
  
  
  OBJECTIVE
  To evaluate the intensity of EOL care among AYA patients with cancer.
  
  
  METHODS
  Cross-sectional study of Kaiser Permanente Southern California (KSPC) cancer registry data and electronic health records for 663 AYA patients with either stage I to III cancer and evidence of cancer recurrence or stage IV cancer at diagnosis. All patients were treated within KSPC, an integrated health care delivery system, and died between 2001 and 2010 before age 40 years (age range at time of death, 15-39 years).
  
  
  METHODS
  (1) Chemotherapy use in the last 14 days of life; (2) intensive care unit (ICU) care in the last 30 days of life; (3) more than 1 emergency department (ED) visit in the last 30 days of life; (4) hospitalization in the last 30 days of life; and (5) a composite measure of medically intensive EOL care including any of the aforementioned measures.
  
  
  RESULTS
  Eleven percent of patients (72 of 663) received chemotherapy within 14 days of death. In the last 30 days of life, 22% of patients (144 of 663) were admitted to the ICU; 22% (147 of 663) had more than 1 ED visit; and 62% (413 of 663) were hospitalized. Overall, 68% of patients (449 of 663) received at least 1 medically intensive EOL care measure.
  
  
  CONCLUSIONS
  Most AYA patients received at least 1 form of medically intensive EOL care. These findings suggest the need to better understand EOL care preferences and decision making in this young population.
authors.affiliation: Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts2Division of Population Sciences' Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Mack
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: Lie H
authors.initials: LH
authors.lastname: Chen
authors.affiliation: Kaiser Permanente Southern California, Pasadena.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Cannavale
authors.affiliation: Kaiser Permanente Southern California, Pasadena.
authors.forename: Olivia
authors.initials: O
authors.lastname: Sattayapiwat
authors.affiliation: Department of Pediatric Oncology, Kaiser Permanente Southern California, Pasadena.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Cooper
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena.
authors.forename: Chun R
authors.initials: CR
authors.lastname: Chao
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002140:California / Q000453:epidemiology; D003422:Critical Care / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D018450:Disease Progression; D057286:Electronic Health Records; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006279:Health Maintenance Organizations; D006295:Health Resources / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009369:Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D057240:Patient Preference; D012189:Retrospective Studies; D018426:SEER Program; D013727:Terminal Care / Q000379:methods / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents