Trends and Outcomes of Early and Late Palliative Care Consultation for Adult Glioblastoma Patients: A SEER-Medicare Retrospective Study

2021 ◽  
Author(s):  
Adela Wu ◽  
Beatrice Ugiliweneza ◽  
Dengzhi Wang ◽  
Gary Hsin ◽  
Maxwell Boakye ◽  
...  
Keyword(s):  
Palliative Care ◽  
Healthcare Costs ◽  
Standard Of Care ◽  
Patient Characteristics ◽  
Positive Trend ◽  
Survival Times ◽  
Early Palliative Care ◽  
Time To Death ◽  
Health Aid ◽  
Palliative Care Consultation

Abstract PurposeGlioblastoma (GBM) carries a poor prognosis despite standard of care. Early palliative care (PC) has been shown to enhance survival and quality of life while reducing healthcare costs for other cancers. No study has investigated differences in PC timing on GBM patient outcomes.MethodsThis study used Surveillance, Epidemiology and End Results (SEER)-Medicare data from 1997-2016. Based on ICD codes, three groups were defined: (1) early PC within 10 weeks of diagnosis, (2) late PC, and (3) no PC. Outcomes were compared between the three groups.ResultsOut of 10,812 GBM patients, 1,648 (15.24%) patients had PC consultation with an overall positive trend over time. There were no significant differences in patient characteristics. There were significant differences in survival among the three groups (P<0.001), with early PC patients with the lowest mean time to death from diagnosis (3.99 ± 4.22 months). The early PC group had significantly lower overall cost of home health aid (1901 ± 3025, p<0.0001) and overall healthcare costs (82842 ± 52726, p<0.0001) compared to other groups. Conclusion We present the first investigation of PC consultation prevalence and outcomes, stratified by early versus late timing, for adult GBM patients. Despite an overall increase in PC consultations, only a minority of GBM patients receive PC. Patients with late PC had the longest survival times. Early PC was associated with lower healthcare costs and resource utilization when accounting for the patients’ entire disease course. Prospective studies can provide additional valuable information about this unique population of GBM patients.

Early Palliative Care Consultation in the Burn Unit: A Quality Improvement Initiative to Increase Utilization

2021 ◽  
Author(s):  
Heather Carmichael ◽  
Hareklia Brackett ◽  
Maurice C Scott ◽  
Margaret M Dines ◽  
Sarah E Mather ◽  
...  
Keyword(s):  
Palliative Care ◽  
Small Sample ◽  
Quality Improvement Initiative ◽  
Comfort Care ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Before And After ◽  
Care Consultation ◽  
Patient Values ◽  
The Impact

Abstract Despite significant morbidity and mortality for major burns, palliative care consultation (PCC) is underutilized in this population. The purpose of this study is to examine the impact of a protocol using recommended “triggers” for PCC at a single academic burn center. This is a retrospective review of patient deaths over a four-year period. Use of life-sustaining treatments, comfort care (de-escalation of one or more life-sustaining treatments) and do not attempt resuscitation (DNAR) orders were determined. Use of PCC was compared during periods before and after a protocol establishing recommended triggers for early (&lt;72 hrs of admission) PCC was instituted in 2019. A total of 33 patient deaths were reviewed. Most patients were male (n=28, 85%) and median age was 62 years [IQR 42-72]. Median revised Baux score was 112 [IQR 81-133]. Many patients had life-sustaining interventions such as intubation, dialysis, or cardiopulmonary resuscitation, often prior to admission. Amongst patients who survived &gt;24 hrs, 67% (n=14/21) had PCC. Frequency of PCC increased after protocol development, with 100% vs. 36% of these patients having PCC before death (p=0.004). However, even during the later period, less than half of patients had early PCC despite meeting criteria at admission. In conclusion, initiation of life-sustaining measures in severely injured burn patients occurs prior to or early during hospitalization. Thus, value-based early goals of care discussions are valuable to prevent interventions that do not align with patient values and assist with de-escalation of life-sustaining treatment. In this small sample, we found that while there was increasing use of PCC overall after developing a protocol of recommended triggers for consultation, many patients who met criteria at admission did not receive early PCC. Further research is needed to elucidate reasons why providers may be resistant to PCC.

scholarly journals Association between opioid dose escalation and time to death in a comfort measures only population

2020 ◽  
Author(s):  
Dana L Abraham ◽  
Inmaculada Hernandez ◽  
Gina T Ayers ◽  
Jennifer A Pruskowski
Keyword(s):  
Palliative Care ◽  
Survival Time ◽  
Dose Escalation ◽  
Hospital Setting ◽  
Mean Difference ◽  
Cox Proportional Hazards Model ◽  
Opioid Dose ◽  
Time To Death ◽  
Published Evidence ◽  
Palliative Care Consultation

Abstract Purpose Opioids are crucial to the relief of pain and dyspnea experienced by patients dying in the hospital setting; however, there are concerns about the association of opioid dosage with hastened death via opioid-induced respiratory depression, and there is little published evidence regarding the association between opioid dose escalation and time to death in the inpatient comfort measures only (CMO) population. Methods The medical records of adult patients admitted to 2 hospitals who had an active CMO order at the time of death and received opioid dose escalations after CMO pronouncement were assessed in a retrospective cohort study. Patients were categorized into higher and lower opioid dose escalation groups according to an institutional palliative care symptom guide. A Cox proportional hazards model was constructed to test the associations between dose escalation group, patient sex, opioid naivety, palliative care consultation, and opioid dosage after CMO pronouncement (independent variables) and time to death (dependent variable). Results In the 71-patient cohort, 39 patients (54.9%) were male and 32 (45.1%) were female. The mean (SD) age of patients was 67.2 (16.6) years. Higher dose escalation (n = 46, 64.8%) was associated with a nonsignificant decrease in survival time compared to lower dose escalation (n = 25, 35.2%), with a mean difference in time to death of 19.8 hours (hazard ratio [HR], 1.67; 95% confidence interval [CI], 0.94-2.97). Receipt of a palliative care consult (n = 56, 78.9%) during the final hospital visit was associated with increased survival time (mean difference, 20.1 hours; HR, 0.32; 95% CI, 0.16-0.63). Conclusion Time to death in an inpatient CMO population was not significantly associated with the degree of opioid dose escalation.

The effect of early palliative care consultation for survival in patients with unresectable pancreatic cancer.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 131-131
Author(s):  
Kazuhiro Kosugi ◽  
Fumio Omata ◽  
Yoshiyuki Fujita ◽  
Akitoshi Hayashi
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
Rank Test ◽  
Unresectable Pancreatic Cancer ◽  
Poor Prognostic Factor ◽  
Early Palliative Care ◽  
Ajcc Stage ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Basic Characteristics

131 Background: Additional early palliative care consultation (EPCC) on standard oncology care (SOC) was reported to prolong survival of patients with metastatic non–small cell lung cancer by one randomized controlled trial. However, its survival benefits for the patients with other advanced cancer have not fully been investigated yet. Pancreatic cancer is one of neoplastic diseases which seldom can be diagnosed in early stage and it is important to know the effectiveness of EPCC. The aim of this study was to determine the effectiveness of EPCC for survival of unresectable pancreatic cancer(UPC). Methods: A retrospective cohort study was conducted in tertiary referral hospital in Tokyo, Japan. 98 patients were diagnosed with UPC between Jan 2004 and February 2007. Candidate variable as predictors for survival analysis included basic characteristics of patients such as age and gender, EPCC, American Joint Committee on Cancer (AJCC) stage, Charlson comorbidity index (CCI), ECOG performance status (PS), and chemotherapy. EPCC was defined as referral to board certified palliative care physician within 30 days after initial diagnosis of UPC. Patients were classified to EPCC with SOC and SOC only group. Bivariate analyses was conducted to compare EPCC with SOC and SOC group. Kaplan-Meier estimates were calculated. Cox proportional hazard model was applied for multivariate analysis. Results: The basic characteristics of patients are described in table. Median estimates of survival [95%CI] were 64 days[21-99] in the group of EPCC with SOC, and 132 days [69-174] in the group of SOC only (P=0.0065, Log-rank test). Adjusted hazard ratio [95% CI] of AJCC stage, chemotherapy, and EPCC was 1.82 [1.02-3.49], 0.41 [0.25-0.70], 2.02 [1.03-3.70], respectively. Conclusions: EPCC may be a significantly poor prognostic factor in the patients with UPC. [Table: see text]

scholarly journals Early Palliative Care Consultation in the Medical ICU

2019 ◽  
Vol 47 (12) ◽  
pp. 1707-1715 ◽  
Author(s):  
Jessica Ma ◽  
Stephen Chi ◽  
Benjamin Buettner ◽  
Katherine Pollard ◽  
Monica Muir ◽  
...  
Keyword(s):  
Palliative Care ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Care Consultation

Cost analysis of a prospective multi-site cohort study of palliative care consultation teams for adults with advanced cancer: Where do cost-savings come from?

2017 ◽  
Vol 31 (4) ◽  
pp. 378-386 ◽  
Author(s):  
Peter May ◽  
Melissa M Garrido ◽  
J Brian Cassel ◽  
Amy S Kelley ◽  
Diane E Meier ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Length Of Stay ◽  
Advanced Cancer ◽  
Intervention Group ◽  
Cost Savings ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Consultation Team ◽  
Care Consultation

Background: Studies report cost-savings from hospital-based palliative care consultation teams compared to usual care only, but drivers of observed differences are unclear. Aim: To analyse cost-differences associated with palliative care consultation teams using two research questions: (Q1) What is the association between early palliative care consultation team intervention, and intensity of services and length of stay, compared to usual care only? (Q2) What is the association between early palliative care consultation team intervention and day-to-day hospital costs, compared to a later intervention? Design: Prospective multi-site cohort study (2007–2011). Patients who received a consultation were placed in the intervention group, those who did not in the comparison group. Intervention group was stratified by timing, and groups were matched using propensity scores. Setting/participants: Adults admitted to three US hospitals with advanced cancer. Principle analytic sample contains 863 patients ( nUC = 637; nPC EARLY = 177; nPC LATE = 49) discharged alive. Results: Cost-savings from early palliative care accrue due to both reduced length of stay and reduced intensity of treatment, with an estimated 63% of savings associated with shorter length of stay. A reduction in day-to-day costs is observable in the days immediately following initial consult but does not persist indefinitely. A comparison of early and late palliative care consultation team cost-effects shows negligible difference once the intervention is administered. Conclusion: Reduced length of stay is the biggest driver of cost-saving from early consultation for patients with advanced cancer. Patient- and family-centred discussions on goals of care and transition planning initiated by palliative care consultation teams may be at least as important in driving cost-savings as the reduction of unnecessary tests and pharmaceuticals identified by previous studies.

Feasibility of Early Palliative Care Consultation for Children With High-Risk Malignancies

2016 ◽  
Vol 63 (8) ◽  
pp. 1419-1422 ◽  
Author(s):  
Laila A. Mahmood ◽  
Denise Casey ◽  
James G. Dolan ◽  
Ann M. Dozier ◽  
David N. Korones
Keyword(s):  
Palliative Care ◽  
High Risk ◽  
Early Palliative Care ◽  
Palliative Care Consultation ◽  
Care Consultation

Cost Savings Associated With Palliative Care Among Older Adults With Advanced Cancer

2021 ◽  
pp. 104990912098680
Author(s):  
Paige E. Sheridan ◽  
Wendi G. LeBrett ◽  
Daniel P. Triplett ◽  
Eric J. Roeland ◽  
Andrew R. Bruggeman ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Healthcare Costs ◽  
Healthcare Expenditure ◽  
Advanced Cancer Patients ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
The Impact

Background: There is inconsistent evidence that palliative care intervention decreases total healthcare expenditure at end-of-life for oncology patients. This inconsistent evidence may result from small sample sizes at single institution studies and disparate characterization of costs across studies. Comprehensive studies in population-based datasets are needed to fully understand the impact of palliative care on total healthcare costs. This study analyzed the impact of palliative care on total healthcare costs in a nationally representative sample of advanced cancer patients. Methods: We conducted a matched cohort study among Medicare patients with metastatic lung, colorectal, breast and prostate cancers. We matched patients who received a palliative care consultation to similar patients who did not receive a palliative care consultation on factors related to both the receipt of palliative care and end of life costs. We compared direct costs between matched patients to determine the per-patient economic impact of a palliative care consultation. Results: Patients who received a palliative care consultation experienced an average per patient cost of $5,834 compared to $7,784 for usual care patients (25% decrease; p < 0.0001). Palliative care consultation within 7 days of death decreased healthcare costs by $451, while palliative care consultation more than 4 weeks from death decreased costs by $4,643. Conclusion: This study demonstrates that palliative care has the capacity to substantially reduce healthcare expenditure among advanced cancer patients. Earlier palliative care consultation results in greater cost reductions than consultation in the last week of life.

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