Association of timing of palliative care with end-of-life quality indicators among patients with ovarian cancer

There is increasing recognition that futile and overly aggressive care at the end of life (EOL) is costly to patients and the health care system. A retrospective cohort study in Ontario, Canada, investigated the association of the timing of palliative care initiation and EOL quality indicators among patients who died from ovarian cancer. In this study of 8297 decedents, initiating palliative care earlier than 3 months before death was associated with lower rates of the composite endpoint aggressive EOL care (OR 0.47; 95% CI 0.37-0.60), death in hospital (0.54; 0.45-0.65), and intensive care unit admission in the last 30 days of life (0.46; 0.27-0.76). Specialist palliative consultation from 3 months up to 6 months before death was assocated with decreased likelihood of chemotherapy in the last 14 days of life (OR 0.46; 95% CI 0.24-0.88). The authors conclude that findings from this cohort study suggest that starting palliative care earlier than three months before end of life was associated with less-aggressive end-of-life care.