title: End-of-life care for hospitalized patients with metastatic melanoma in France: a nationwide, register-based study.
abstract: BACKGROUND
  Although the aggressiveness of end-of-life cancer care has come under great scrutiny over the past two decades, little is known about the intensity of care and treatments in the last months of life of patients with metastatic melanoma.
  
  
  OBJECTIVE
  To measure the prevalence of aggressive cancer care use, and to assess the frequency of palliative care referral over the course of the last 3 months of life of hospitalized patients who died from metastatic melanoma.
  
  
  METHODS
  A nationwide register-based study in France was carried out, including all hospitalized adults aged ≥ 20 years who died from metastatic melanoma in metropolitan France between 2010 and 2013.
  
  
  RESULTS
  Of 3889 patients who died from metastatic melanoma, 51·9% received chemotherapy in the last 3 months before death, 25·9% in the last month, 12·9% in the last 2 weeks and 7·6% in the last week. On average, patients were hospitalized for 31·7 days over the course of their last 3 months of life. During the final month before death, 12·0% of patients received radiation therapy, 14·0% received blood transfusion, 12·1% were transferred into an intensive care unit and 19·7% remained hospitalized continuously. Palliative care needs were identified in 78·4% of patients, with variations according to the type of facility. In total 17% of all patients died in palliative care inpatient units.
  
  
  CONCLUSIONS
  Treatment intensity near the end of life of patients with metastatic melanoma raises concerns for the quality of care. There is a need for clinical guidelines and adequate support to facilitate patient-physician communication and to improve access to palliative care services.
authors.affiliation: Department of Dermatovenereology, Karolinska Hospital and Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: I
authors.initials: I
authors.lastname: Gallais Sérézal
authors.affiliation: Department of Palliative Care, Besançon University Hospital, Besançon, France.|INSERM CIT808, Besançon University Hospital, Besançon, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Beaussant
authors.affiliation: Medical Oncology, Institut Paoli-Calmettes, Marseille, France.
authors.forename: P
authors.initials: P
authors.lastname: Rochigneux
authors.affiliation: Oncology Department, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France.|Paris-Est Créteil University, Créteil, France.
authors.forename: C
authors.initials: C
authors.lastname: Tournigand
authors.affiliation: Department of Palliative Care, Besançon University Hospital, Besançon, France.|INSERM CIT808, Besançon University Hospital, Besançon, France.
authors.forename: R
authors.initials: R
authors.lastname: Aubry
authors.affiliation: Department of Dermatovenereology, Karolinska Hospital and Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Lindelöf
authors.affiliation: Aging Research Center, Karolinska Institutet and Stockholm University, Gävlegatan 16, 11330, Stockholm, Sweden. lucas.morin@ki.se.
authors.forename: L
authors.initials: L
authors.lastname: Morin
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D012042:Registries; D017678:Sex Distribution; D012878:Skin Neoplasms / Q000401:mortality / Q000628:therapy*; D013727:Terminal Care / Q000706:statistics & numerical data*; D055815:Young Adult