Palliative care at the end of life among patients with cancer before and during the COVID-19 pandemic

The COVID-19 pandemic has had a large impact on cancer care, resulting in restrictions to hospital and community services as well as to inpatient visitors. Although palliative care has been shown to improve outcomes for patients with cancer, there has been no large-scale study on how the COVID-19 pandemic has affected the delivery of palliative care. Our aim is to understand the impact of the COVID-19 pandemic on the use of palliative care services at the end of life for patients with cancer. We will conduct this study in two parts. In Part 1, we will use Ontario's healthcare data, which are routinely collected for all patients receiving healthcare in hospitals (as outpatients, inpatients or in emergency rooms) or at home. Using these data, we will compare palliative care near the end of life (e.g. whether, when, and how often a palliative care service was involved in the patient's care) as well as acute care use in the last month of life (e.g. attending the emergency department or hospital admissions) before versus during the COVID-19 pandemic. We will also determine if any changes in receiving palliative care services before versus during the COVID-19 pandemic are greater among patients from areas of Ontario that are more affected by poverty. In Part 2, we will use individual and group interviews to understand the perspectives and experiences of bereaved family caregivers and healthcare workers regarding access to palliative care at the end of life for patients with cancer who died during the pandemic. We will use these results to complement and explain our results from healthcare data. Our research team includes experienced researchers, clinicians and policy-makers, in order to ensure that the results of our research are incorporated into practice. This project will help inform strategies to improve the delivery of palliative care for patients with cancer during and beyond the ongoing COVID-19 pandemic.