Achievement of a good death among young adult patients with cancer: analyses of combined data from three nationwide surveys among bereaved family members

PurposeAlthough little improvement has been made in the survival rate among young cancer patients over recent decades, whether they have achieved a good death has never been systematically explored. We aimed to clarify whether young cancer patients (aged 20-39years) have achieved a good death, and compare their achievement with that of middle-aged patients (aged 40-64years).MethodsWe analyzed combined data of three nationwide, cross-sectional surveys of families of cancer patients who died at inpatient hospices in Japan (2007-2014). We measured 10 core items of the Good Death Inventory (GDI) short-version on a 7-point scale, and calculated rates of agree/absolutely agree and the mean scores.ResultsWe analyzed 245 and 5140 responses of families of young and middle-aged patients, respectively. Less than 60% of families of young patients reported agree/absolutely agree regarding 9 items, which included feeling that one's life was completed in 44 (18%; 95% confidence interval (CI)=14-23%), being independent in daily life in 48 (20%; 95% CI=15-25%), and being free from physical distress in 103 (42%; 95% CI=36-48%) young patients. Young patients were significantly less likely to feel one's life was completed (mean=3.3 (standard deviation=2.0) vs. 3.8 (1.9), respectively; effect size (ES)=0.29; adjusted p value=0.000) and not being a burden to others (3.1 (1.5) vs. 3.5 (1.6), respectively; ES=0.24; adjusted p value=0.010) than the middle-aged.ConclusionsOverall, young cancer patients did not achieve a good death. Future efforts are needed to improve the quality of palliative care for young patients, focusing on psychosocial/spiritual suffering.