End-of-Life Care Among Patients With Bipolar Disorder and Cancer: A Nationwide Cohort Study.

Abstract:

OBJECTIVE:This study aimed to describe end-of-life (EOL) care in individuals with bipolar disorder (BD) who died of cancer compared with mentally healthy individuals. METHODS:This was a nationwide cohort study of all adult individuals who died of cancer in hospitals in France between 2013 and 2016. Outcomes were compared between individuals with BD and mentally healthy individuals in the last month of life including palliative care and high-intensity EOL care (chemotherapy, artificial nutrition, and other interventions). A subanalysis explored differences between patients with BD and patients with schizophrenia. RESULTS:The study included 2015 individuals with BD and 222,477 mentally healthy controls. Compared with the controls, individuals with BD died 5 years earlier, more often had comorbidities and thoracic cancer, and had fewer metastases, but did not have shorter delays from cancer diagnosis to death. After matching and adjustment for covariates, individuals with BD more often received palliative care in the last 3 days of life (25% versus 13%, p < .001) and less high-intensity care (e.g., chemotherapy 12% versus 15%, p = .004), but more artificial nutrition (6% versus 4.6%, p = .003). Compared with the schizophrenia comparison group, chemotherapy was received more by individuals with BD in the last 14 days of life (12.5% for BD versus 9.4%, p < .001). CONCLUSIONS:Individuals with BD were more likely to receive palliative care and less likely to receive high-intensity EOL care, except for artificial nutrition. These results may not be specific to BD, as no difference was found between patients with BD and schizophrenia except for chemotherapy.

journal_name

Psychosom Med

journal_title

Psychosomatic medicine

authors

Fond G,Baumstarck K,Auquier P,Pauly V,Bernard C,Orleans V,Llorca PM,Lancon C,Salas S,Boyer L

doi

10.1097/PSY.0000000000000839

subject

Has Abstract

pub_date

2020-09-01 00:00:00

pages

722-732

issue

7

eissn

0033-3174

issn

1534-7796

journal_volume

82

pub_type

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