Study looks at palliative care use in adolescents, young adults with cancer

For adolescents and young adults (AYA) with cancer, the likelihood of receiving specialty palliative care (SPC) is increased for those reporting moderate or severe symptoms, according to a study published online Oct. 20 in JAMA Network Open.

Sumit Gupta, M.D., Ph.D., from The Hospital for Sick Children in Toronto, and colleagues examined whether patient-reported symptom severity was associated with subsequent SPC involvement in AYAs (aged 15 to 29 years) with primary cancer diagnosed between Jan. 1, 2010, and June 30, 2018. Data were included for 5,435 AYAs with cancer, with a median follow-up of 5.1 years.

The researchers found that moderate and severe versus mild Edmonton Symptom Assessment System scores were associated with an increased likelihood of SPC involvement for all symptoms. Pain scores had the greatest magnitude of association (hazard ratio for severe versus mild, 7.7).

Within five years of diagnosis, 13.3% of AYAs died; 84.9% of these 721 patients had received SPC before death. There was an association seen for SPC involvement with improved pain trajectories in 202 case-control pairs (mean scores improved from 3.41 to 3.07 in case patients; worsened from 1.86 to 2.16 in control patients). No impact was seen on other symptom trajectories.

"In this cohort study of AYAs with cancer, those reporting moderate or severe symptoms in the context of a provincial screening program were more likely to subsequently receive PC services, suggesting that such programs have a role in ensuring PC involvement for AYAs in need," the authors write.

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