Is There a Role for Routine Specialty Palliative Care Consultation in Cancer Patients Undergoing Curative- Intent Surgery?

6638 Background: Access to specialist palliative care (hospital-based or hospice) is a recognized measure of quality in cancer care. Most cancer centers do have palliative care consult services, although the availability of a comprehensive program that includes a palliative care unit and outpatient clinic (Hui 2010) is inconsistent. A simultaneous integrated model of palliative care that facilitates earlier access to a specialized palliative care team may improve clinical outcomes. Palliative care programs should measure the access, timing and impact of their clinical service. Methods: Hospital claims data were linked to Social Security Death Index (SSDI) data from the US Department of Commerce. 3,128 adult cancer patients died between January 2009 and July 2011 and had contact with our inpatient palliative care team in their last six months of life. We determined whether IPC earlier than 1 month prior to death had an impact on hospitalizations, in-hospital mortality and referral to hospice. Results: 27.5% of cancer decedents accessed IPC, median of 22 days before death. 13.2% were discharged to hospice, median of 13 days before death. Patients with IPC earlier than 1 month until death were more likely to have hospice and fewer in-hospital deaths but there was no association between early IPC and a 30-day mortality admission. Conclusions: Palliative care services are accessed by a minority of patients and typically in the last 2-3 weeks of life. Although in-hospital deaths were reduced by earlier palliative care consultation, 30 day mortality did not improve. Hospitals may need to implement other strategies including early integration of outpatient palliative care among cancer patients, to achieve an impact on 30-day mortality admissions. [Table: see text]

Download Full-text

Impact of a Palliative Care Consultation Team on Cancer-Related Symptoms in Advanced Cancer Patients Referred to an Outpatient Supportive Care Clinic

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2010.03.017 ◽

2011 ◽

Vol 41 (1) ◽

pp. 49-56 ◽

Cited By ~ 99

Author(s):

Sriram Yennurajalingam ◽

Diana L. Urbauer ◽

Katie L.B. Casper ◽

Cielito C. Reyes-Gibby ◽

Ray Chacko ◽

...

Keyword(s):

Palliative Care ◽

Supportive Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Advanced Cancer Patients ◽

Care Clinic ◽

Palliative Care Consultation ◽

Consultation Team ◽

Care Consultation ◽

Outpatient Supportive Care

Download Full-text

Penghematan Biaya Perawatan Pasien Kanker Terminal Dewasa melalui Konsultasi Tim Paliatif di Rumah Sakit Dr. Cipto Mangunkusumo

Jurnal Penyakit Dalam Indonesia ◽

10.7454/jpdi.v4i1.111 ◽

2017 ◽

Vol 4 (1) ◽

pp. 35 ◽

Cited By ~ 1

Author(s):

Rudi Putranto ◽

Laksono Trisnantoro ◽

Yos Hendra

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Significant Relationship ◽

End Of Life Care ◽

Terminal Cancer ◽

Life Care ◽

Palliative Care Consultation ◽

Terminal Cancer Patients ◽

Care Consultation ◽

The Relationship

Pendahaluan. Meningkatnya penderita kanker terminal di Indonesia akan meningkatkan kebutuhan perawatan paliatif dan akhir kehidupan (palliative and end of life care). Pelayanan kesehatan pada pasien kanker membebani rumah sakit, karena menyebabkan biaya tinggi dan lama rawat memanjang. Penelitian ini bertujuan untuk mengevaluasi hubungan lama rawat inap dan tarif pelayanan rawat inap pasien kanker terminal dewasa dengan intervensi paliatif di Rumah Sakit dr. Cipto Mangunkusumo (RSCM).Metode. Penelitian ini adalah deskriptif analitik dengan desain kasus kontrol dan dilakukan di ruang rawat inap RSCM Jakarta selama bulan Januari–Desember 2015. Subjek adalah pasien kanker terminal dewasa di rawat inap kelas III pada tahun Januari-Desember 2015 dengan penjamin Badan Penyelenggara Jaminan Sosial (BPJS). Data diperoleh dari data rekam medis dan billing dan dianalisis menggunakan uji Mann-Whitney.Hasil. Diketahui bahwa terdapat hubungan yang signifikan antara intervensi paliatif dengan pengeluaran pasien sesuai tarif RS (p=0,041), sedangkan tidak terdapat hubungan signifikan antara intervensi paliatif dengan lama hari rawat (p=0,873). Terdapat hubungan bermakna antara intervensi paliatif dan tarif pengeluaran kamar, visite, tindakan dan obat dan intervensi paliatif.Simpulan. Terdapat hubungan yang signifikan antara intervensi paliatif dengan pengeluaran pasien sesuai tarif RS. Terdapat hubungan bermakna antara intervensi paliatif dan tarif pengeluaran kamar, visite, tindakan dan obat dan intervensi paliatif.Kata Kunci: intervensi, lama rawat, perawatan paliatif, tarif Cost of Care Saving of Terminal Cancer Adult Patient Using Palliative Care Consultation in Cipto Mangunkusumo HospitalIntroduction. Terminal cancer patients was increasing in Indonesia, and need attention to approach palliative and end of life care. Terminal cancer management was burden the hospital, because it causes high costly and the length of stay This study aimed to get a general picture of service palliative at Cipto Mangunkusumo, then to evaluate the relationship hospitalization and rates of inpatient services people with terminal cancer adults who received the intervention palliative care and to evaluate the relationship variable rates for accommodation (room), doctor visit, procedure/surgery, medicines and consumables, laboratory and radiology to palliative interventions in patients with terminal cancer in inpatient Dr. Cipto Mangunkusumo Hospital. Methods. This research was descriptive study with case control design and performed in the inpatient unit, Dr Cipto Mangunkusumo Hospital, during the month of January to December 2015. The subjects were medical records and billing of terminal cancer patients were .hospitalized adults in class III in January - December 2015 with National Health Insurance (BPJS). Inclusion criteria are terminal cancer patients, beusia ≥ 18 years, received palliative care consultation team while exclusion criteria are patients receiving palliative consultation on treatment days ≥ 25 days.Results. It is known that there is a significant relationship between palliative interventions to patients with hospital rates (p= 0.041), whereas there was no significant relationship between palliative interventions by the length of stay (p = 0.873). There is a significant relationship between palliative interventions and expenditures room rates, visite, action and medicine and palliative interventions.Conclusions. There is a significant relationship between palliative interventions with hospital rates. There is a significant relationship between palliative interventions and expenditures room rates, visite, action and medicine and palliative interventions. These data showed that palliative care intervention was saving money for hospital.

Download Full-text

Patterns of palliative care consultation among elderly cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.15_suppl.e17557 ◽

2015 ◽

Vol 33 (15_suppl) ◽

pp. e17557-e17557

Author(s):

Eric Roeland ◽

Daniel P Triplett ◽

Rayna Matsuno ◽

Isabel Boero ◽

Lindsay Hwang ◽

...

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Elderly Cancer Patients ◽

Palliative Care Consultation ◽

Care Consultation

Download Full-text

Improving access to specialist multidisciplinary palliative care consultation for rural cancer patients by videoconferencing: report of a pilot project

Supportive Care in Cancer ◽

10.1007/s00520-012-1649-7 ◽

2012 ◽

Vol 21 (4) ◽

pp. 1201-1207 ◽

Cited By ~ 50

Author(s):

Sharon M. Watanabe ◽

Alysa Fairchild ◽

Edith Pituskin ◽

Patricia Borgersen ◽

John Hanson ◽

...

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Pilot Project ◽

Palliative Care Consultation ◽

Care Consultation

Download Full-text

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

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120986800 ◽

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.

Download Full-text

Perspectives on palliative care in a multisite oncology practice.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.52 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 52-52

Author(s):

Kenneth D. Bishop ◽

Angela Marie Taber

Keyword(s):

Palliative Care ◽

Pain Management ◽

Cancer Patients ◽

Nurse Practitioners ◽

Effective Means ◽

Cancer Center ◽

Care Services ◽

Palliative Care Consultation ◽

Palliative Care Services ◽

Care Consultation

52 Background: The Institute of Medicine reported that many cancer patients do not receive palliative care to manage symptoms. It is possible that practitioners do not identify palliative care as an important component of high-quality cancer care, or do not know how to most efficiently utilize available palliative care consultative services. Methods: An anonymous electronic survey was sent to physicians, nurses, nurse practitioners, physician assistants, and social workers (n=99) in our multi-site, single-institution Cancer Center. Results: Sixty-five responses were received (66% response rate). Eighty-three percent of respondents reported working primarily in the outpatient setting. Fifty-nine percent reported their patients ‘rarely use the ER for pain management’ while 16% reported their patients ‘frequently require ER visits for pain management’. Ninety-two percent considered palliative care ‘an integral part of a multidisciplinary team’ while 6% reported palliative care consultation to be ‘cumbersome to consult and coordinate with’. The most common reason for consultation was end-of-life discussions (38%) followed by chronic pain management (33%). Seventy-seven percent reported consulting between 1 and 5 times per month, 14% between 6-10 times per month, and 5% greater than 11 times per month. Thirteen percent reported that they were able to manage patient symptoms adequately themselves. The average rating for convenience of consulting palliative care was 3.8/5. Fifty-eight percent reported the most effective means of communication with palliative care consultants was through the medical record, whereas 42% reported that most effective communication took place in person. Sixty percent reported a preference for palliative care practitioners from within the division of hematology/oncology. Conclusions: Our survey suggests that the majority of oncology practitioners value palliative care consultation and are willing to incorporate palliative care services into patient management. It is possible that practitioners overestimate their utilization of palliative care services and that optimizing the convenience of consultation and communication would result in better integration of palliative care for cancer patients.

Download Full-text