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

Abstract

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.