The health care cost of palliative care for cancer patients: a systematic review

73 Background: Palliative care early in the cancer disease trajectory may improve health related quality of life for patients and their families. Collaboration between community and specialist health care professionals is paramount to achieve optimal cancer care. The objective of this study is to develop and to implement this model into our health care system.The target population is cancer patients with metastatic and/ or loco-regional disease. Methods: The study takes place in a rural district of 13 municipalities with a local hospital (Orkdal) in Mid Norway. It is designed as a prospective controlled observational pre- post cohort study with four main interventions: 1. Development and implementation of a standardized care pathway across health care levels, 2. Educational programme for health care professionals, 3. Information about cancer and palliative care to the public, 4.Information,education and support to family members.Outcomes are patient’s time spent at home, family member’s health related quality of life, improvement of health care providers’ knowledge and skills and distribution of health care service use. Results: A standardized care pathway for all palliative cancer patients including home care, care in nursing homes, and specialist care in hospitals (in- and outpatients) is developed. It focuses on access to palliative care services, transfer of medical data, and symptom assessment. The educational program consists of two parts; one to inform about the project and the standardized care pathway, and one to improve competence and skills in cancer palliative care. To the general public, information regarding chemo- and radiotherapy, symptom diagnosis and treatment and palliative care services in general is given. Conclusions: A total integrated model to improve care for cancer patients was developed focusing on collaboration between community and specialist health care, and on early integration of palliative care in the traditional cancer care trajectory. Improved care for cancer patients and their families in the Orkdal region to equal costs is expected. The Orkdal Model may be applied in other regions and for other chronic diseases. Clinical trial information: NCT02170168.

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Palliative care and end-of-life health utilization in elder patients with pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.488 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 488-488

Author(s):

Nizar Bhulani ◽

Ang Gao ◽

Arjun Gupta ◽

Jenny Jing Li ◽

Chad Guenther ◽

...

Keyword(s):

Health Care ◽

Pancreatic Cancer ◽

Intensive Care Unit ◽

Palliative Care ◽

Intensive Care ◽

Health Care Utilization ◽

End Of Life ◽

Cancer Patients ◽

Cost Of Care ◽

Care Utilization

488 Background: Prospective trials have shown that palliative care is associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients. Methods: Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room and Intensive Care utilization and costs in the last 30 days of life were assessed. Statistical analyses were performed with SAS version 9.4 (SAS Institute, Inc., Cary, NC). Results: Of the 72205 patients with pancreatic cancer, 3383 (4.1%) received palliative care. The proportion of patients receiving palliative care increased from 1.8% in 2000 to 7.8% in 2009 (p for trend < 0.001). Patients with palliative care were more likely to be Asian and women. Of those who received palliative care, 73% received it in the last 30 days of life, and only 11% at least 12 weeks before death. The average number of visits to the ED in the last 30 days of life were significantly higher for patients who received palliative care (0.93±0.62) versus those who did not (0.79±0.61), p < 0.001, and had a significantly higher cost of care ($1317 vs $842, p < 0.001). Intensive care unit length of stay in the last 30 days of life did not differ between patients who did and did not receive palliative care (1.14 days vs 1.04 days, p 0.08). Intensive care unit cost of care was significantly higher for patients with palliative care compared to their counterparts ($5202.641 vs $3896.750, p < 0.001). Conclusions: Palliative care use for pancreatic cancer patients has increased between 2000 and 2009 in this study of Medicare patients. However, it was largely offered close to the end of life and was not associated with reduced health care utilization or cost. Early palliative care referral may be more beneficial.

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Effect of pediatric palliative care programs on health care resource utilization and costs among children with life-threatening conditions: a systematic review of comparative studies

CMAJ Open ◽

10.9778/cmajo.20140044 ◽

2015 ◽

Vol 3 (1) ◽

pp. E68-E75 ◽

Cited By ~ 23

Author(s):

T. Conte ◽

C. Mitton ◽

L. M. Trenaman ◽

N. Chavoshi ◽

H. Siden

Keyword(s):

Systematic Review ◽

Health Care ◽

Palliative Care ◽

Resource Utilization ◽

Comparative Studies ◽

Health Care Resource ◽

Pediatric Palliative Care ◽

Health Care Resource Utilization ◽

Life Threatening

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Palliative care services: Issues and public health challenges

South East Asia Journal of Public Health ◽

10.3329/seajph.v2i2.15937 ◽

2013 ◽

Vol 2 (2) ◽

pp. 5-15

Author(s):

Riawati Jahja

Keyword(s):

Public Health ◽

Quality Of Life ◽

Systematic Review ◽

Health Care ◽

Palliative Care ◽

Observational Studies ◽

Care Services ◽

Review Articles ◽

Palliative Care Services

Trials have demonstrated improvement in patients quality of life through palliative care services (PCS). However, many of these trials are limited by their research methodologies. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched to conduct a systematic review of review articles related to PCS from January 2001 to December 2011. The paper examined evidence from studies on PCS that aimed to improve elderly patients end-of-life outcomes by i) systematically reviewing literature on models of palliative care (PC) delivery patients received; ii) exploring methodological issues surrounding recruitment of the patients, implementation of the studies and comparison of health care services; and iii) addressing the costs of care with/without a palliative program. Seventeen trials and three observational studies were selected from nine systematic review articles. Overall, early introduction of PC to patients following identification of their life-limiting conditions and needs re-quires an organized and coordinated care approach to ensure accessibility of these services. The ideal system that offers the potential of improving patients quality of life is one that is integrated, interdisciplinary and holistic. Dying is commonly institutionalized; however, providing outreach programs that allow patients to die at their place of wish, such as domiciliary care, offers the potential of addressing the issue of ever-increasing health-care expenditure for the aged. However, further investigation is needed to evaluate the cost effectiveness of these programs. Methodological problems and ethical issues surrounding the study of terminally-ill patients necessitate that researchers use a combination of observational studies and surveillance system over time. DOI: http://dx.doi.org/10.3329/seajph.v2i2.15937 South East Asia J Public Health | Jul-Dec 2012 | Vol 2 Issue 2 | 5-15

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Resilience for family carers of advanced cancer patients—how can health care providers contribute? A qualitative interview study with carers

Palliative Medicine ◽

10.1177/0269216318777656 ◽

2018 ◽

Vol 32 (8) ◽

pp. 1410-1418 ◽

Cited By ~ 14

Author(s):

Ingebrigt Røen ◽

Hans Stifoss-Hanssen ◽

Gunn Grande ◽

Anne-Tove Brenne ◽

Stein Kaasa ◽

...

Keyword(s):

Health Care ◽

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Health Care Providers ◽

Support Needs ◽

Care Providers ◽

Family Carers ◽

Advanced Cancer Patients ◽

Qualitative Interview Study

Background: Caring for advanced cancer patients affects carers’ psychological and physical health. Resilience has been defined as “the process of adapting well in the face of adversity, trauma, tragedy, threats or even significant sources of threat.” Aim: The aim of this study was to explore factors promoting carer resilience, based on carers’ experiences with and preferences for health care provider support. Design: Qualitative, semi-structured, individual interviews with family carers of advanced cancer patients were performed until data saturation. The interviews were recorded, transcribed, and analyzed using systematic text condensation. Setting/participants: Carers ( n = 14) of advanced cancer patients, not receiving curative treatment, admitted to an integrated curative and palliative care cancer outpatient clinic or to a university hospital cancer clinic, were included. Results: 14 carers of advanced cancer patients were included; 7 men, 7 women, and mean age of 59 years; 3 were bereaved; 12 were partners; 5 had young and teenage children. Four main resilience factors were identified: (1) being seen and known by health care providers—a personal relation; (2) availability of palliative care; (3) information and communication about illness, prognosis, and death; and (4) facilitating a good carer–patient relation. Conclusion: Health care providers may enhance carers’ resilience by a series of simple interventions. Education should address carers’ support needs and resilience. Systematic assessment of carers’ support needs is recommended. Further investigation is needed into how health care providers can help carers and patients communicate about death.

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Improving Nutritional Management of Cancer Patients in Tanzania

Journal of Global Oncology ◽

10.1200/jgo.18.20900 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 108s-108s

Author(s):

H. Martin ◽

J. Kimiywe ◽

P. Petrucka ◽

L. Kamanga

Keyword(s):

Health Care ◽

Palliative Care ◽

Cancer Patients ◽

Low Income ◽

Dietary Habits ◽

Health Care Facilities ◽

Nutritional Management ◽

National Hospital ◽

Nutritional Care ◽

Nutrition Care

Background: Cancer is one of the leading causes of death worldwide and was reported to cause 8.8 million deaths in 2015. It was long predicted that about 70% of the new cancer cases will be in low-income countries (LIC). In Tanzania, like in many LICs, the need for improved cancer care is critical because cancer rates are rising dramatically. Most cancers are detected late and hence high mortality and poor palliative care for patients. Tanzania lacks trained clinical nutritionists and dieticians to manage different conditions including cancer. Aim: The aim of this project is to build the capacity of nutritionists and other health personnel to provide nutrition care to cancer patients in hospitals. Methods: One nutritionist from Tanzania will be attached to the Kenyatta National Hospital in Kenya for one month to obtain practical experience on the nutritional management of cancer patients. The acquired knowledge will be disseminated among health care professionals in Tanzania, specifically, nutritionist and nurses in selected health care facilities. About six nutrition officers and six nurses who work in Ocean Road Cancer Institute, Bugando Hospital, KCMC hospital and Muhimbili National Hospital will be trained by the incumbent on nutrition care for cancer patients once the fellowship visit has been completed. In addition, a study to identify differences in nutritional care for cancer patients between Tanzania and Kenya will be conducted. Cancer patients visiting hospitals in Tanzania and Kenya will be asked to complete a questionnaire that will assess their nutritional care in detail. Responses from cancer patients from each country will be compared to identify differences. Results: Expected results from this project includes, the transfer of knowledge in nutritional management of cancer patients between Tanzania and Kenya, and the subsequent dissemination of this knowledge to other nutrition specialists based in the home country, Tanzania. Further results will include data obtained from a survey that will be performed on cancer patients from both countries regarding their nutritional care. This study is also expected to open up collaborative research opportunities between the universities and health facilities on best practices for nutrition care and support for cancer patients. Conclusion: This study will not only improve palliative care among cancer patients but will also create more awareness on preventive measures against cancers with emphasis on dietary habits.

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