End-of-life care for hospitalized patients with metastatic melanoma in France: a nationwide, register-based study

Summary Background Although the aggressiveness of end‐of‐life cancer care has come under great scrutiny over the past two decades, little is known about the intensity of care and treatments in the last months of life of patients with metastatic melanoma. Objectives To measure the prevalence of aggressive cancer care use, and to assess the frequency of palliative care referral over the course of the last 3 months of life of hospitalized patients who died from metastatic melanoma. Methods A nationwide register‐based study in France was carried out, including all hospitalized adults aged ≥ 20 years who died from metastatic melanoma in metropolitan France between 2010 and 2013. Results Of 3889 patients who died from metastatic melanoma, 51·9% received chemotherapy in the last 3 months before death, 25·9% in the last month, 12·9% in the last 2 weeks and 7·6% in the last week. On average, patients were hospitalized for 31·7 days over the course of their last 3 months of life. During the final month before death, 12·0% of patients received radiation therapy, 14·0% received blood transfusion, 12·1% were transferred into an intensive care unit and 19·7% remained hospitalized continuously. Palliative care needs were identified in 78·4% of patients, with variations according to the type of facility. In total 17% of all patients died in palliative care inpatient units. Conclusions Treatment intensity near the end of life of patients with metastatic melanoma raises concerns for the quality of care. There is a need for clinical guidelines and adequate support to facilitate patient–physician communication and to improve access to palliative care services. What's already known about this topic? The aggressiveness of cancer care near the end of life has come under great scrutiny in the past two decades. Little is known about end‐of‐life care in patients with metastatic melanoma. What does this study add? Patients with metastatic melanoma receive aggressive end‐of‐life care in France. Younger patients were more likely to receive aggressive cancer care near the end of life. The early identification of palliative care needs remains infrequent. Linked Comment: Fox. Br J Dermatol 2016; 175:462–463.