Systemic Anti-Cancer Therapy Use in Palliative Care Outpatients With Advanced Cancer

2020 ◽  
pp. 082585972097594
Author(s):  
Deepa Wadhwa ◽  
David Hausner ◽  
Gordana Popovic ◽  
Ashley Pope ◽  
Nadia Swami ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Therapy ◽  
Advanced Cancer ◽  
Multinomial Logistic Regression ◽  
Multivariable Analysis ◽  
Related Factors ◽  
Factors Associated ◽  
Palliative Care Consultation ◽  
Anti Cancer ◽  
Care Consultation

Purpose: To evaluate factors associated with continuation of systemic anti-cancer therapy (SACT) after palliative care consultation, and SACT administration in the last 30 days of life, in outpatients with cancer referred to palliative care. Timing of referral was of particular interest. Methods: Patient, disease, and treatment-related factors associated with SACT before and after palliative care, and in the last 30 days of life, were identified using 3-level multinomial logistic regression. Referral to palliative care was categorized by time from death as early (>12 months), intermediate (6-12 months), and late (≤6 months). Results: Of the 337 patients, 240 (71.2%) received SACT for advanced cancer; of these, 126 (52.5%) received SACT only prior to palliative care while 114 (47.5%) also received SACT afterward. Only 35/337 (10.4%) received SACT in the last 30 days of life. On multivariable analysis, factors associated with continuing SACT after palliative care consultation were a cancer diagnosis for <1 year (OR 3.09, p = 0.01), breast primary (OR 11.88, p = 0.0008), and early (OR 28.8, p < 0.001) or intermediate (OR 6.67, p < 0.001) referral timing. No factors were significantly associated with receiving SACT in the last 30 days versus earlier, but the median time from palliative care referral to death in those receiving SACT in the last 30 days versus stopping SACT earlier was 1.78 versus 4.27 months. Conclusion: Patients who received SACT following palliative care consultation were more likely to be referred early; however, patients receiving SACT in their last 30 days tended to be referred late.

Do hospitalized cancer patients requiring palliative care consultation discharged to subacute rehabilitation ever get anticancer therapy again?

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 62-62
Author(s):  
Muhammad Azeem Khan ◽  
Clint S. Pettit ◽  
Hunter Groninger
Keyword(s):  
Palliative Care ◽  
Cancer Therapy ◽  
Cancer Treatment ◽  
Advanced Cancer ◽  
Functional Decline ◽  
Goals Of Care ◽  
Discharge Disposition ◽  
Patients With Cancer ◽  
Palliative Care Consultation ◽  
Anti Cancer

62 Background: Patients with advanced cancer inevitably experience a functional decline that is often associated with notable symptom burden and/or indications for clarification of goals. Palliative care (PC) services frequently engage such patients during hospital stays. For many of these patients, discharge plans to sub-acute rehabilitation facilities (SAR) in order to ‘gain strength’ for future cancer treatment is a common practice. We wished to examine if inpatients with advanced cancer receiving PC consultation who are discharged to SAR are ever able to follow up with their oncology team and receive anti-cancer therapy. Methods: A search was conducted in our institution’s electronic medical system for hospitalized patients with cancer who received inpatient PC consultation and were subsequently discharged to SAR. Patients were excluded if they did not follow with an oncologist at MWHC as an out patient prior to the admission being reviewed or if they had never received anti cancer therapy before. Results: From 2015-2017, 16 patients meeting our criteria were identified. For 14 (82.4%) patients Palliative Care was consulted to either discuss goals of care and/or assist with pain management.13 (76%) patients were discharged to SAR to ‘improve strength’. However only 7 (44%) patients saw their oncologist after discharge from SAR. Of those 7 only 3 (19%) received further anti cancer therapy. 4 of the 7 (57%) patients that saw their oncologist after SAR had an ECOG of 1 on admission, the other 3 had an ECOG of 2. No patient with an ECOG of 2 or greater ever received cancer treatment again. Exactly half of the 16 patients were eventually readmitted to our hospital. Conclusions: SAR may not be an appropriate discharge disposition for patients with cancer who have a decline in functional status. Less than half the patients with cancer discharged to SAR from our institute with the intention to gain strength for future chemotherapy saw their oncologist again and the overwhelming majority (particularly those with an ECOG performance score of 2 and greater) never received anti cancer therapy again. This data can be considered to make informed decisions when discussing goals of care.

scholarly journals Effect of Palliative Care on Aggressiveness of End-of-Life Care Among Patients With Advanced Cancer

2017 ◽  
Vol 13 (9) ◽  
pp. e760-e769 ◽  
Author(s):  
Daniel P. Triplett ◽  
Wendi G. LeBrett ◽  
Alex K. Bryant ◽  
Andrew R. Bruggeman ◽  
Rayna K. Matsuno ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
End Of Life ◽  
Advanced Cancer ◽  
Health Care Use ◽  
Medicare Beneficiaries ◽  
Invasive Procedures ◽  
Chemotherapy Administration ◽  
Palliative Care Consultation ◽  
Care Consultation

Purpose: Palliative care’s role in oncology has expanded, but its effect on aggressiveness of care at the end of life has not been characterized at the population level. Methods: This matched retrospective cohort study examined the effect of an encounter with palliative care on health-care use at the end of life among 6,580 Medicare beneficiaries with advanced prostate, breast, lung, or colorectal cancer. We compared health-care use before and after palliative care consultation to a matched nonpalliative care cohort. Results: The palliative care cohort had higher rates of health-care use in the 30 days before palliative care consultation compared with the nonpalliative cohort, with higher rates of hospitalization (risk ratio [RR], 3.33; 95% CI, 2.87 to 3.85), invasive procedures (RR, 1.75; 95% CI, 1.62 to 1.88), and chemotherapy administration (RR, 1.61; 95% CI, 1.45 to 1.78). The opposite pattern emerged in the interval from palliative care consultation through death, where the palliative care cohort had lower rates of hospitalization (RR, 0.53; 95% CI, 0.44-0.65), invasive procedures (RR, 0.52; 95% CI, 0.45 to 0.59), and chemotherapy administration (RR, 0.46; 95% CI, 0.39 to 0.53). Patients with earlier palliative care consultation in their disease course had larger absolute reductions in health-care use compared with those with palliative care consultation closer to the end of life. Conclusion: This population-based study found that palliative care substantially decreased health-care use among Medicare beneficiaries with advanced cancer. Given the increasing number of elderly patients with advanced cancer, this study emphasizes the importance of early integration of palliative care alongside standard oncologic care.

Utilization of support services, emergency department, and hospital in advanced cancer patients with severe disease in a community cancer institute.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 112-112
Author(s):  
Caitlyn McNaughton ◽  
Emily Gehron ◽  
Shanthi Sivendran ◽  
Rachel Holliday ◽  
Michael Horst ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Advanced Cancer ◽  
Support Services ◽  
Symptom Management ◽  
Severe Disease ◽  
Hospital Utilization ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Ed Visits

112 Background: Patients with advanced cancer are at high risk for emergency department (ED) and hospital utilization, which is distressing and costly. Palliative care consultation and symptom management clinics have been shown to decrease ED and hospital utilization, but the frequency and composition of these interventions is still being delineated. More evaluation is needed to determine practical approaches to implementing interdisciplinary management of distress for patients with advanced cancer in the community setting. This retrospective review evaluates healthcare utilization with respect to support services provided in our community based cancer institute. Methods: 157 patients with advanced cancer of lung, gastrointestinal, genitourinary or gynecologic origin diagnosed January 2015-December 2015 were reviewed retrospectively. Descriptive data including demographics, disease characteristics, palliative care consultation, support services utilized and ED visits/hospitalizations were collected for 12 months, or to date of death. Support services included physician assistant–led symptom management, nurse navigator, social worker, nutrition, financial counselor, chaplain, and oncology clinical counselor. Support service referrals were made based on identified needs. Severe disease was defined as death within 6 months of diagnosis. Results: Patients with severe disease had a mean of 6 ED visits per year, significantly greater than patients with non-severe disease (p < 0.001). Patients with severe disease also had more contacts with support services per year (30.3 vs 9.1, p < 0.001). A palliative care consult was placed in 50% of patients with severe disease, and 23% in patients with non-severe disease (p < 0.001). Conclusions: Patients with advanced cancer have evidence of significant needs as reflected by high healthcare utilization in the last 6 months of life. As needed involvement of support services correlated with severity of disease but did not result in decreased ED utilization or hospitalization. This suggests that availability of support services alone is not a feasible strategy to impact unplanned hospitalizations and ED visits.

scholarly journals Impact of Automatic Palliative Care Consultation for Hospitalized Patients with Advanced Cancer (S759)

2014 ◽  
Vol 47 (2) ◽  
pp. 501-502
Author(s):  
Gabrielle Rocque ◽  
Toby Campbell ◽  
Jens Eickhoff ◽  
Renae Quale ◽  
Anne Barnett ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advanced Cancer ◽  
Hospitalized Patients ◽  
Palliative Care Consultation ◽  
Care Consultation

scholarly journals Racial Differences in Palliative Care Consultation for Inpatients with Advanced Cancer (SA523-A)

2014 ◽  
Vol 47 (2) ◽  
pp. 461-462
Author(s):  
Rashmi Sharma ◽  
Jamie Von Roenn ◽  
Frank Penedo ◽  
Kenzie Cameron ◽  
Joan Chmiel
Keyword(s):  
Palliative Care ◽  
Racial Differences ◽  
Advanced Cancer ◽  
Palliative Care Consultation ◽  
Care Consultation
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