Oncology-embedded supportive care and end-of-life outcomes: a comparative study of hospice-eligible Muslim patients with cancer and non-cancer diagnoses.

PURPOSE: Oncology-embedded supportive care facilitates comfort-focused end-of-life care in cancer patients, but its effectiveness in Muslim-majority settings is unknown. We compared end-of-life outcomes between hospice-eligible Muslim cancer patients managed within this model and non-cancer patients without such integration.

METHODS

This retrospective cohort study (2021-2024) at a Middle Eastern tertiary hospital included hospice-eligible Muslim adults who died during an acute-care admission. Cancer patients were managed by an oncology-embedded supportive service and compared with non-cancer patients. The primary outcome was a comfort-oriented care composite reflecting goal-concordant care (do-not-attempt-resuscitation [DNAR] at death without ICU admission). Multivariable analysis adjusted for key confounders, including age, comorbidities, and palliative care involvement.

RESULTS

Of 54,122 admissions and 2171 deaths, 796 hospice-eligible patients were analyzed (401 cancer, 395 non-cancer). The comfort-oriented care composite was achieved more often in cancer patients (71% vs 35%, p < 0.001). Cancer patients had earlier DNAR transitions (median 7 vs 13 days after admission), lower ICU utilization (21% vs 58%), and fewer aggressive interventions in the final 24 h (34% vs 70%), all p < 0.001. In multivariable analysis, cancer diagnosis (aOR 2.24, 95% CI 1.39-3.59) and palliative involvement (aOR 3.18, 95% CI 2.03-4.99) independently predicted comfort-oriented care.

CONCLUSIONS

An oncology-embedded supportive care model in a Muslim-majority setting was associated with earlier transitions to comfort-focused care and less aggressive end-of-life interventions among hospice-eligible cancer patients. The contrast with non-cancer patients highlights the importance of structured supportive care integration and demonstrates that models adapted to cultural and religious contexts can effectively support comfort-focused care.