Quality of End-of-Life Care for Adolescent and Young Adult Patients with Cancer and Depression and Grief in Bereaved Families: A Secondary Analysis.

BACKGROUND

Adolescent and young adult (AYA) patients with cancer face numerous challenges, particularly at the end-of-life. However, little is known about how the patients and their families experience end-of-life care.

OBJECTIVE

We aimed to compare the quality of end-of-life palliative care and the levels of depression and grief among bereaved families of AYAs and middle-aged patients with cancer, and to identify associated factors.

METHODS

We conducted a secondary analysis of a nationwide mortality follow-back survey based on death certificates of patients who died from cancer in 2017 and 2018. Subjects were classified into two groups AYA (aged 20-39 years) and the middle-aged (aged 40-64 years). End-of-life quality was evaluated using the Care Evaluation Scale, Good Death Inventory, and Memorial Symptom Assessment Scale. Depression and grief levels among bereaved family members were also evaluated.

RESULTS

We analyzed 261 and 5790 bereaved families from the AYA and middle-aged groups, respectively. While the quality of end-of-life palliative care did not differ clinically significantly between the AYA and middle-aged group, the levels of grief and depression were significantly higher in the AYA compared with the middle-aged group (Effect Size [ES] = 0.57, p < 0.0001; ES = 0.22, p = 0.001, respectively).

CONCLUSION

Although end-of-life care quality was comparable between AYAs and middle-aged patients, bereaved families of AYA patients experienced significantly greater grief and depression. These findings underscore the need for tailored bereavement support for AYA families.