Does early integration of palliative care services improve outcomes for patients with advanced cancer over usual care?

AbstractObjective:Routine early integration of palliative care with advanced cancer management is not yet a part of standard practice in many countries, including mainland China. Whether patients in China suffering from advanced cancer are referred to palliative care services in a timely manner remains unclear. We sought to investigate the timing of palliative care referral of Chinese cancer patients at our center and its predictors.Method:Retrospective medical data including demographic characteristics and referral information were collected for analysis. A total of 759 patients referred to our palliative care unit (PCU) from January of 2007 to December of 2013 were included in the final analysis.Results:The mean age of the 759 patients included in the study was 62.89 years (range 61.95–63.82). Some 369 patients (48.6%) were male and 559 (73.6%) Shanghainese (indigenous). Lung cancer (17.9%) was the most common diagnosis. The time interval since enrollment into the PCU until a patient's death (length of stay, LOS) was calculated. A longer LOS indicated earlier referral to inpatient PC services. The median LOS was 21 days (CI95% = 19.79–22.21). Multivariate analysis showed that whether or not the patient was indigenous (p = 0.002) and younger than 65 (p = 0.031) were independent factors for a longer LOS. Such other characteristics as gender and primary cancer type bore no relationship to LOS.Significance of results:Our findings demonstrate that Chinese cancer patients are referred relatively late in the course of their disease to inpatient palliative care services. To overcome the barriers to early integration of palliative care into a patient's treatment plan, accurate information about palliative care must be provided to both oncologists and patients via comprehensive and systematic educational programs.

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Early integration of palliative care services with standard oncology care for patients with advanced cancer

CA A Cancer Journal for Clinicians ◽

10.3322/caac.21192 ◽

2013 ◽

Vol 63 (5) ◽

pp. 349-363 ◽

Cited By ~ 155

Author(s):

Joseph A. Greer ◽

Vicki A. Jackson ◽

Diane E. Meier ◽

Jennifer S. Temel

Keyword(s):

Palliative Care ◽

Advanced Cancer ◽

Early Integration ◽

Care Services ◽

Palliative Care Services ◽

Oncology Care

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Impact and timing of palliative care referral.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.50 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 50-50

Author(s):

Leslie J Blackhall ◽

Paul W Read ◽

George Stukenborg ◽

Margaret Barclay ◽

Patrick M Dillon ◽

...

Keyword(s):

Palliative Care ◽

End Of Life ◽

Advanced Cancer ◽

Outcome Data ◽

Control Group ◽

Care Clinic ◽

Early Integration ◽

Care Services ◽

Patient Reported ◽

Palliative Care Services

50 Background: Recent studies suggest that early integration of palliative care services into the care of patients with advanced cancer can improve end of life care. Unfortunately, there are insufficient resources for all advanced cancer to see palliative care from time of diagnosis. This 2012 CMS innovation award is attempting to improve identification of cancer patients in need of palliative care. Methods: In Year 1 of this award, increased staffing was added to existing palliative care resources to improve access. Patients were referred at discretion of their oncologist. A control group consisting of patients with similar diagnoses not referred to palliative care was identified including those without any contact with palliative care, and those who only saw palliative care in the hospitalization prior to death. Data regarding hospitalization in the last month of life, and hospice utilization was obtained. Results: Median time between referral to palliative care clinic and death was 72.5 days (mean 112). See table below. Conclusions: These data suggest patients referred to palliative care clinic within 3 months of death had benefits similar referral at time of diagnosis. However, many patients were never referred or referred only at the very end of life. The next phases of this award will utilize patient-reported outcome data to better identify those who need palliative care. Although most palliative care services are hospital-based, in this study, in-patient consultation only was too late to provide much benefit for these patients. Re-focusing scarce palliative care resources to the out-patient setting may have greater impact on patient care. [Table: see text]

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Correction to: Content validation of the EORTC QLQ-C15-PAL with advanced cancer patients and health care professionals from palliative care services in Chile

BMC Palliative Care ◽

10.1186/s12904-020-00656-4 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Leslye Rojas-Concha ◽

Maiken Bang Hansen ◽

Morten Aagaard Petersen ◽

Mogens Groenvold

Keyword(s):

Health Care ◽

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Health Care Professionals ◽

Content Validation ◽

Advanced Cancer Patients ◽

Care Services ◽

Palliative Care Services ◽

Eortc Qlq

An amendment to this paper has been published and can be accessed via the original article.

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Do Patients with Advanced Cancer and Unmet Palliative Care Needs Have an Interest in Receiving Palliative Care Services?

Journal of Palliative Medicine ◽

10.1089/jpm.2013.0537 ◽

2014 ◽

Vol 17 (6) ◽

pp. 667-672 ◽

Cited By ~ 19

Author(s):

Yael Schenker ◽

Seo Young Park ◽

Rachael Maciasz ◽

Robert M. Arnold

Keyword(s):

Palliative Care ◽

Advanced Cancer ◽

Care Needs ◽

Care Services ◽

Palliative Care Services ◽

Palliative Care Needs

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Integration of specialty palliative care in a phase I ovarian cancer population.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.31_suppl.75 ◽

2019 ◽

Vol 37 (31_suppl) ◽

pp. 75-75

Author(s):

Marisa R Moroney ◽

Breana Hill ◽

Jeanelle Sheeder ◽

Jennifer Robinson Diamond ◽

Melony Avella-Howell ◽

...

Keyword(s):

Ovarian Cancer ◽

Palliative Care ◽

Clinical Trials ◽

Phase I ◽

Cancer Patients ◽

Advanced Cancer ◽

Disease Stage ◽

Phase I Clinical Trials ◽

Care Services ◽

Palliative Care Services

75 Background: ASCO guidelines recommend patients with advanced cancer receive early integrated specialty palliative care based on evidence of multiple clinical benefits. To our knowledge, there is no literature evaluating utilization of specialty palliative care in Phase I clinical trial patients, but there is limited data demonstrating underutilization of palliative care services in patients with life-threatening diseases including advanced cancer. Methods: A retrospective review of ovarian cancer patients enrolled in Phase I clinical trials at one institution from 2008 to 2018. Charts were reviewed for patient and disease characteristics including age, disease stage, number of chemotherapy regimens and date of death. Charts were also reviewed to determine if and when patients received specialty palliative care services. Results: A total of 121 patients with ovarian cancer were enrolled in Phase I clinical trials. Median age at time of Phase I enrollment was 59 years (range 33-88). 87% of patients had advanced stage disease: 60% Stage III and 27% Stage IV. Median number of chemotherapy regimens received prior to Phase I enrollment was 5 (range 1-13). Median survival was 311 days (95%CI 225.9-396.1). Of the 121 patients, 4 (3.3%) received specialty palliative care prior to Phase I enrollment, 7 (5.8%) within 30 days after enrollment, and 53 (43.8%) more than 30 days after enrollment. 57 patients (47.1%) never received specialty palliative care. Conclusions: Ovarian cancer patients enrolled in Phase I clinical trials have advanced cancer – defined by ASCO as disease that is late-stage and life limiting with a prognosis less than 24 months – and should therefore receive early integrated specialty palliative care. This study demonstrates that a significant portion of Phase I ovarian cancer patients are either receiving no or late integration of specialty palliative care. Further work needs to focus on increasing early integration of specialty palliative care in this population.

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Content validation of the EORTC QLQ-C15-PAL with advanced cancer patients and health care professionals from palliative care services in Chile

10.21203/rs.2.17678/v1 ◽

2019 ◽

Author(s):

Leslye Rojas-Concha ◽

Maiken Bang Hansen ◽

Morten Aagaard Petersen ◽

Mogens Groenvold

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Advanced Cancer ◽

Health Care Professionals ◽

Life Questionnaire ◽

Advanced Cancer Patients ◽

Care Services ◽

Palliative Care Services ◽

Eortc Qlq

Abstract Background: The assessment of patients’ quality of life (QOL) is essential when evaluating the outcome of palliative care; however, no instruments have been validated for measuring symptoms and QOL in patients receiving palliative care in Chile. We aimed to investigate the content validity of the EORTC Quality of Life Questionnaire Core 15 Palliative Care (QLQ-C15-PAL), replicating the methods used previously to shorten the EORTC Quality of Life Questionnaire Core 30 (QLQ-C30) for use among patients in palliative care.Methods: This cross-sectional study was conducted from October to November 2017 in four palliative care services. Patients with advanced cancer and health care professionals (HCPs) were invited to individual interviews to determine the relevance, appropriateness and relative importance of the 30 items of the QLQ-C30 for evaluating the outcome of palliative care, and whether relevant additional issues should be included. Results: A total of 48 patients and 35 HCPs participated. The most important dimensions selected were pain, physical functioning, sleeping difficulties, emotional functioning, nausea/vomiting, fatigue, and social functioning. Qualitative data identified important additional issues not covered by the questionnaire such as satisfaction with care, emotions and psychological support, as well as linguistic issues in the dyspnea and constipation items. Conclusions: The EORTC QLQ-C15-PAL showed good content validity in the assessment of symptoms and QOL of advanced cancer patients; therefore, we recommend the use of this questionnaire in palliative care in Chile. Dyspnea and constipation items were revised by the EORTC group. More research is needed to add a social dimension for a comprehensive assessment of patients’ QOL.

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Content validation of the EORTC QLQ-C15-PAL with advanced cancer patients and health care professionals from palliative care services in Chile

BMC Palliative Care ◽

10.1186/s12904-020-00586-1 ◽

2020 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Leslye Rojas-Concha ◽

Maiken Bang Hansen ◽

Morten Aagaard Petersen ◽

Mogens Groenvold

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Advanced Cancer ◽

Health Care Professionals ◽

Life Questionnaire ◽

Advanced Cancer Patients ◽

Care Services ◽

Palliative Care Services ◽

Eortc Qlq

Abstract Background The assessment of patients’ quality of life (QOL) is essential when evaluating the outcome of palliative care; however, no instruments have been validated for measuring symptoms and QOL in patients receiving palliative care in Chile. We aimed to investigate the content validity of the EORTC Quality of Life Questionnaire Core 15 Palliative Care (QLQ-C15-PAL), replicating the methods used previously to shorten the EORTC Quality of Life Questionnaire Core 30 (QLQ-C30) for use among patients in palliative care. Methods This cross-sectional study was conducted from October to November 2017 in four palliative care services. Patients with advanced cancer and health care professionals (HCPs) were invited to individual interviews to determine the relevance, appropriateness and relative importance of the 30 items of the QLQ-C30 for evaluating the outcome of palliative care, and whether relevant additional issues should be included. Results A total of 48 patients and 35 HCPs participated. The most important dimensions selected were pain, physical functioning, sleeping difficulties, emotional functioning, nausea/vomiting, fatigue, social functioning, lack of appetite, role functioning and constipation. Qualitative data identified important additional issues not covered by the questionnaire such as satisfaction with care, emotions and psychological support, as well as linguistic issues in the dyspnea and constipation items. Conclusions The EORTC QLQ-C15-PAL showed good content validity in the assessment of symptoms and QOL of advanced cancer patients; therefore, we recommend the use of this questionnaire in palliative care in Chile. Dyspnea and constipation items were revised by the EORTC group. More research is needed to add a social dimension for a comprehensive assessment of patients’ QOL.

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