Iqbal and Zimmermann
​Dr. Javaid Iqbal, (L), a doctoral student at Princess Margaret Cancer Centre, is first author of the study; Dr. Camilla Zimmermann, Senior Scientist at the Princess Margaret and Head and Lederman Chair in the Department of Supportive Care at the cancer centre, is the senior author. (Photo: UHN Research Communications)

By UHN Research Communications

A new study from UHN's Princess Margaret Cancer Centre found that the CO​VID-19 pandemic caused more patients with cancer to die at home and led to less receipt of specialized palliative care.

The pandemic also amplified socioeconomic disparities in death at home and delivery of end-of-life care.

"Studies suggest that most patients with advanced cancer prefer to receive end-of-life care at home and to die at home," says Dr. Camilla Zimmermann, Senior Scientist at the Princess Margaret and senior author of the study.

"When cancer patients can receive specialized palliative care and follow their preference to die at home, they usually enjoy a better quality of life at the end of their life and a better quality of death," adds Dr. Zimmermann, who is also a professor in the Department of Medicine at the University of Toronto.

Although the COVID-19 pandemic had a significant impact on the delivery of cancer care, less is known about its influence on the place of death, delivery of specialized palliative care and disparities in these outcomes due to socioeconomic status.

Dr. Zimmermann's team set out to determine whether the end-of-life experience is equitable across socioeconomic statuses and whether the pandemic played a role in increasing inequities.

"We analyzed data from a pool of over 170,000 Ontario patients who died with cancer from 2015 to 2021 to determine whether there was a change in home deaths and specialized palliative care delivery before and during the pandemic, using patient socioeconomic status as subgroups," says Dr. Javaid Iqbal, a doctoral student at the Princess Margaret and first author of the study.

"We found that both before and during the pandemic, patients with the lowest socioeconomic status were least likely to die at home and to receive palliative care at the end of life," adds Dr. Iqbal.

Palliative care is physical, psychosocial, and spiritual care that is provided to patients with an incurable or life-threatening disease. Specialized palliative care is provided by a multidisciplinary team trained at an advanced level and can improve the quality of life for patients. (Photo: Getty Images)

Despite a substantial surge of patients who died at home during COVID, the home death increase in the lowest socioeconomic group was less marked than in other groups.

In addition, although the pandemic disrupted overall access to palliative care, this was more evident in the lowest socioeconomic group. Unlike the other groups where the surge in home death occurred both in patients receiving and not receiving palliative care, low socioeconomic patients had a significant home death increase only in those without this care.

These findings indicate that the pandemic increased socioeconomic disparities in end-of-life care and identify a need to deliver this care more broadly and equitably in the future.

"Future research should focus on the mechanisms of these disparities to develop interventions that ensure equitable and consistent access to palliative care," concludes Dr. Zimmermann.

This work was supported by the Canadian Institutes of Health Research, Canada Graduate Scholarship, the Peterborough KM Hunter Charitable Foundation and The Princess Margaret Cancer Foundation.

Co-author Dr. Monika Krzyzanowska reported being a principal investigator for trials with Eli Lilly, Exelixis, and Novartis, and receiving advisory board fees from Ipsen. Co-author Dr. Jenny Lau received funding from the Health Canada Health Care Policy and Strategies Program.

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