[Anticipating intensive care decisions in oncology: Evolution of the use of the INFO REA tool at the Léon-Bérard Cancer Center (2020-2024)].

INTRODUCTION

With the increasing incidence of cancer in France and improved oncological outcomes, the profile of hospitalized cancer patients and approaches to care limitation have evolved. INFO REA is a decision-support tool used at the Léon-Bérard Center, a comprehensive cancer center in Lyon, to document intensive care preferences.

METHODS

This retrospective monocentric study aimed to describe changes in the availability and content of INFO REA status for patients hospitalized at CLB between 2020 and 2024. Data on the presence of an INFO REA, the type of documented status, and the presence of advance directives were analyzed.

RESULTS

Among the 125,839 hospitalizations analyzed, the availability of INFO REA status significantly decreased (60% in 2020 versus 49% in 2024), although it remained high in conventional medical wards (>90%). The proportion of patients with full-code status increased (24% in 2020 to 29% in 2024), while care limitation statuses declined. Among deceased patients, the proportion with exclusive comfort care status rose (53% in 2020 to 72% in 2024). Advance directives remained infrequently documented (<4%).

DISCUSSION: These trends raise questions about the alignment of medical management with oncological prognosis in the absence of documented anticipatory decisions. This tool unfortunately does not allow us to know how implicated patients are in this decision and if they understood properly the situation. The systematic use of the INFO REA tool, combined with multidisciplinary discussion, may help improve care planning in oncology.