End-of-life care among patients with bipolar disorder and cancer: a nationwide cohort study.

OBJECTIVE To describe end-of-life (EOL) care in individuals with bipolar disorder (BD) who died from cancer compared to mentally healthy individuals. METHODS This was a nationwide cohort study of all adult individuals who died from cancer in hospitals in France between 2013 and 2016. Outcomes were compared between individuals with BD versus mentally healthy individuals in the last month of life including palliative care and high-intensity EOL care (chemotherapy, artificial nutrition, and other interventions). A sub-analysis explored differences between patients with BD and patients with schizophrenia. RESULTS The study included 2015 individuals with BD and 222,477 mentally healthy controls. Compared to the controls, individuals with BD died 5 years earlier, more often had comorbidities and thoracic cancer, and had fewer metastases, but did not have shorter delays from cancer diagnosis to death. After matching and adjustment for covariates, individuals with BD more often received palliative care in the last 3 days of life (25% vs. 13%, p<0.001), and less high-intensity care (e.g., chemotherapy 12% vs. 15%, p=0.004), but more artificial nutrition (6% vs 4.6%, p=0.003). Compared with the schizophrenia comparison group, chemotherapy was received more by individuals with BD in the last 14 days of life (12. 5% for BD vs 9.4%, p<0.001). CONCLUSIONS Individuals with BD were more likely to receive palliative care and less likely to receive high-intensity EOL care, except for artificial nutrition. These results may not be specific to BD, as no difference was found between patients with BD and schizophrenia except for chemotherapy.