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McLouth LE, Borger T, Hoerger M, Stapleton JL, McFarlin J, Heckman PE, Bursac V, Shearer A, Shelton B, Mullett T, Studts JL, Goebel D, Thind R, Trice L, Schoenberg NE. Clinician perspectives on delivering primary and specialty palliative care in community oncology practices. Support Care Cancer 2024; 32:627. [PMID: 39222247 DOI: 10.1007/s00520-024-08816-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Clinical guidelines recommend early palliative care for patients with advanced lung cancer. In rural and underserved community oncology practices with limited resources, both primary palliative care from an oncologist and specialty palliative care are needed to address patients' palliative care needs. The aim of this study is to describe community oncology clinicians' primary palliative care practices and perspectives on integrating specialty palliative care into routine advanced lung cancer treatment in rural and underserved communities. METHODS Participants were clinicians recruited from 15 predominantly rural community oncology practices in Kentucky. Participants completed a one-time survey regarding their primary palliative care practices and knowledge, barriers, and facilitators to integrating specialty palliative care into advanced-stage lung cancer treatment. RESULTS Forty-seven clinicians (30% oncologists) participated. The majority (72.3%) of clinicians worked in a rural county. Over 70% reported routinely asking patients about symptom and physical function concerns, whereas less than half reported routinely asking about key prognostic concerns. Roughly 30% held at least one palliative care misconception (e.g., palliative care is for only those who are stopping cancer treatment). Clinician-reported barriers to specialty palliative care referrals included fear a referral would send the wrong message to patients (77%) and concern about burdening patients with appointments (53%). Notably, the most common clinician-reported facilitator was a patient asking for a referral (93.6%). CONCLUSION Educational programs and outreach efforts are needed to inform community oncology clinicians about palliative care, empower patients to request referrals, and facilitate patients' palliative care needs assessment, documentation, and standardized referral templates.
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Affiliation(s)
- Laurie E McLouth
- Department of Behavioral Science, University of Kentucky College of Medicine, 760 Press Avenue, 467 Healthy Kentucky Research Building, Lexington, KY, USA.
- Center for Health, Engagement, and Transformation, University of Kentucky, Lexington, KY, USA.
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA.
| | - Tia Borger
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Psychiatry, University of Kentucky, Lexington, KY, USA
| | - Michael Hoerger
- Departments of Psychology, Psychiatry, and Medicine, Freeman School of Business and Tulane Cancer Center, Tulane University, New Orleans, USA
- Department of Palliative Medicine and Supportive Care, University Medical Center of New Orleans, New Orleans, USA
| | - Jerod L Stapleton
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Health, Behavior and Society, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Jessica McFarlin
- Department of Neurology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Patrick E Heckman
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Vilma Bursac
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Andrew Shearer
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Brent Shelton
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Timothy Mullett
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
- Department of Surgery, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Jamie L Studts
- Department of Medicine, University of Colorado School of Medicine, University of Colorado Cancer Center, Aurora, USA
| | - David Goebel
- King's Daughters Health System, Ashland, KY, USA
| | | | | | - Nancy E Schoenberg
- Department of Behavioral Science, University of Kentucky College of Medicine, 760 Press Avenue, 467 Healthy Kentucky Research Building, Lexington, KY, USA
- Center for Health, Engagement, and Transformation, University of Kentucky, Lexington, KY, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
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2
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Oswalt CJ, Nakatani MM, Troy J, Wolf S, Locke SC, LeBlanc TW. Timing of Palliative Care Consultation Impacts End of Life Care Outcomes in Metastatic Non-Small Cell Lung Cancer. J Pain Symptom Manage 2024:S0885-3924(24)00858-3. [PMID: 39002711 DOI: 10.1016/j.jpainsymman.2024.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 07/02/2024] [Accepted: 07/07/2024] [Indexed: 07/15/2024]
Abstract
CONTEXT Early specialist palliative care (PC) involvement in metastatic non-small cell lung cancer (mNSCLC) is associated with improved quality of life, less aggressive end of life (EoL) care, and longer survival. As treatment paradigms for NSCLC have evolved, PC utilization remains low. OBJECTIVES This work examines how the timing and extent of PC involvement impacts outcomes and the patient experience in mNSCLC in the era of immunotherapy. METHODS This retrospective review analyzed patients with mNSCLC who initiated first-line treatment with chemotherapy, immunotherapy, or combined chemoimmunotherapy at Duke University between March 2015 and July 2019. PC consultation and outcomes data were abstracted through November 2022. EoL care variables were analyzed using descriptive statistics. RESULTS 152 patients were stratified based on whether PC was consulted during their disease course. 80 patients (53%) never saw PC, while the 72 patients (47%) who saw PC were further stratified by time to first PC encounter and total number of PC visits. 31% were seen within two months of diagnosis (early), 33% between two and six months (intermediate), and 36% after 6 months (late). Patients who received early PC had longer median time on hospice (35 days), had lower rates of aggressive EoL care (43%), and experienced less frequent in-hospital death (14%) compared to other groups. CONCLUSION This real-world study reveals that referrals to PC still occur late or not at all in mNSCLC despite demonstrated benefits of early PC integration. Early outpatient PC referrals resulted in longer time on hospice, lower frequency of aggressive EoL care, and lower rates of in-hospital death.
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Affiliation(s)
- Cameron J Oswalt
- Duke Cancer Institute (C.J.O., S.C.L., T.W.L.B.,), Durham, North Carolina, USA.
| | - Morgan M Nakatani
- Medicine-Psychiatry Resident (M.M.N.), Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jesse Troy
- Department of Biostatistics and Bioinformatics (J.T., S.W.), Division of Biostatistics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Steven Wolf
- Department of Biostatistics and Bioinformatics (J.T., S.W.), Division of Biostatistics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Susan C Locke
- Duke Cancer Institute (C.J.O., S.C.L., T.W.L.B.,), Durham, North Carolina, USA
| | - Thomas W LeBlanc
- Duke Cancer Institute (C.J.O., S.C.L., T.W.L.B.,), Durham, North Carolina, USA
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Murmann M, Manuel DG, Tanuseputro P, Bennett C, Pugliese M, Li W, Roberts R, Hsu AT. Estimated mortality risk and use of palliative care services among home care clients during the last 6 months of life: a retrospective cohort study. CMAJ 2024; 196:E209-E221. [PMID: 38408785 PMCID: PMC10896599 DOI: 10.1503/cmaj.221513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND In Canada, only 15% of patients requiring palliative care receive such services in the year before death. We describe health care utilization patterns among home care users in their last 6 months of life to inform care planning for older people with varying mortality risks and evolving care needs as they decline. METHODS Using population health administrative data from Ontario, we performed a retrospective cohort study involving home care clients aged 50 years and older who received at least 1 interRAI (Resident Assessment Instrument) Home Care assessment between April 2018 and September 2019. We report the proportion of clients who used acute care, long-term care, and palliative home care services within 6 months of their assessment, stratified by their predicted 6-month mortality risk using a prognostic tool called the Risk Evaluation for Support: Predictions for Elder-life in their Communities Tool (RESPECT) and vital status. RESULTS The cohort included 247 377 adults, 11.9% of whom died within 6 months of an assessment. Among decedents, 50.6% of those with a RESPECT-estimated median survival of fewer than 3 months received at least 1 nonphysician palliative home care visit before death. This proportion declined to 38.7% and 29.5% among decedents with an estimated median survival between 3 and 6 months and between 6 and 12 months, respectively. INTERPRETATION Many older adults in Ontario do not receive any palliative home care before death. Prognostic tools such as RESPECT may improve recognition of reduced life expectancies and palliative care needs of individuals in their final years of life.
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Affiliation(s)
- Maya Murmann
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Douglas G Manuel
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Peter Tanuseputro
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Carol Bennett
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Michael Pugliese
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Wenshan Li
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Rhiannon Roberts
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Amy T Hsu
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont.
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Allaudeen N, Millhouse CF, Huberman DB, Wang H, Heidenreich PA. Late to Palliate? Inpatient Palliative Care Consultation at an Academic Veterans Affairs Hospital. Mil Med 2023; 188:e3363-e3367. [PMID: 36794805 DOI: 10.1093/milmed/usad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/25/2023] [Accepted: 02/01/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Despite robust evidence describing the benefits of palliative care consultation (PCC), this service is underutilized. Hospital admission provides an important opportunity to obtain PCC. METHODS We evaluated all inpatients who received PCC at a Veterans Affairs academic hospital from January 1, 2019 to December 31, 2019. Logistic regression was used to determine factors associated with early versus late PCC, with early defined as >30 days from consult to death and late defined as ≤30 days. RESULTS The median time from PCC to death was 37 days. The majority of PCCs were early (58.4%). Of all patients receiving inpatient PCC, 13.2% died that admission. Cardiac (odds ratio = 0.3, 95% CI = 0.11-0.73) and neurological (odds ratio = 0.21, 95% CI = 0.05-0.70) diagnoses were more likely to receive early PCC compared to malignancy. Of the late PCCs receiving first-time consults, 58.9% had at least one admission during the last year. CONCLUSIONS Many patients are introduced to palliative care services within a month of death. These patients were often admitted during the prior year, presenting a missed opportunity to involve inpatient PCC earlier.
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Affiliation(s)
- Nazima Allaudeen
- Medical Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | | | - David B Huberman
- Research Administration Office, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Hui Wang
- Cooperative Studies Program Palo Alto Coordinating Center, Veterans Affairs Palo Alto Health Care System, Mountain View, CA 94043, USA
| | - Paul A Heidenreich
- Medical Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, USA
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Lycan TW, Buckenheimer A, Ruiz J, Russell G, Dothard AS, Ahmed T, Grant S, Grey C, Petty WJ. Team-Based Hospice Referrals: A Potential Quality Metric for Lung Cancer in the Immunotherapy Era. Am J Hosp Palliat Care 2023; 40:10-17. [PMID: 35512681 PMCID: PMC9815203 DOI: 10.1177/10499091221091745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) can lead to durable responses in patients with lung cancer but may delay transitions to hospice at the end of life (EOL). We aimed to test the association of continuity of care with EOL outcomes in the ICI era. METHODS We collected retrospective data on all patients with lung cancer who started ICI treatment at a single comprehensive cancer center in the United States (1/1/14-5/1/18) and subsequently died. We defined a hospice referral as having continuity of care if placed by a provider from the patient's multidisciplinary cancer team (e.g., a medical oncologist, palliative care specialist, intensivist, and hospitalist). RESULTS In this cohort of 143 patients, 58% had a team-based hospice referral which was associated with a lower risk of death in the hospital. The most common reason patients declined hospice at EOL was an unwillingness to discontinue cancer-directed therapy. As compared to a similar historical cohort of patients treated with chemotherapy alone (2008-2010), there was a similar rate of hospice referral (68% vs 74%) but higher rates of new systemic therapy initiated within 30 days of death (17% vs 6%, p .001) and last dose within 14 days of death (13% vs 5%, p .005). CONCLUSIONS Future studies should test the continuity of care at EOL as a new quality metric for advanced NSCLC.
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Affiliation(s)
- Thomas W. Lycan
- Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Alyssa Buckenheimer
- Hospice abd Palliative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jimmy Ruiz
- Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Gregory Russell
- Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Andy Shipe Dothard
- Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Tamjeed Ahmed
- Hematology and Oncology, Tennessee Oncology, Gallatin, TN, USA
| | - Stefan Grant
- Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Carl Grey
- Hospice abd Palliative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - William J. Petty
- Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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6
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Utilization of palliative care resource remains low, consuming potentially avoidable hospital admissions in stage IV non-small cell lung cancer: a community-based retrospective review. Support Care Cancer 2022; 30:10117-10126. [PMID: 36374328 PMCID: PMC9661463 DOI: 10.1007/s00520-022-07364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022]
Abstract
Purpose Early referral of patients with stage IV non-small cell lung cancer (NSCLC) to outpatient palliative care has been shown to increase survival and reduce unnecessary healthcare resource utilization. We aimed to determine outpatient palliative care referral rate and subsequent resource utilization in patients with stage IV NSCLC in a multistate, community-based hospital network and identify rates and reasons for admissions within a local healthcare system of Washington State. Methods A retrospective chart review of a multistate hospital network and a local healthcare system. Patients were identified using ICD billing codes. In the multistate network, 2844 patients diagnosed with stage IV NSCLC between January 1, 2013, and March 1, 2018, were reviewed. In the state healthcare system, 283 patients between August 2014 and June 2017 were reviewed. Results Referral for outpatient palliative care was low: 8% (217/2844) in the multistate network and 11% (32/283) in the local healthcare system. Early outpatient palliative care (6%, 10/156) was associated with a lower proportion of patients admitted into the intensive care unit in the last 30 days of life compared to no outpatient palliative care (15%, 399/2627; p = 0.003). Outpatient palliative care referral was associated with improved overall survival in Kaplan Meier survival analysis. Within the local system, 51% (104/204) of admissions could have been managed in outpatient setting, and of the patients admitted in the last 30 days of life, 59% (87/147) experienced in-hospital deaths. Conclusion We identified underutilization of outpatient palliative care services within stage IV NSCLC patients. Many patients with NSCLC experience hospitalization the last month of life and in-hospital death. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-07364-0.
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7
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Patel S, Hoge G, Fellman B, Kaur S, Heung Y, Bruera E, Hui D. Timing of referral to outpatient palliative care for patients with haematologic malignancies. Br J Haematol 2022; 198:974-982. [PMID: 35866185 DOI: 10.1111/bjh.18365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 11/27/2022]
Abstract
Outpatient palliative-care facilitates timely supportive-care access; however, there is a paucity of studies on the timing of referral in the outpatient setting for patients with haematologic malignancy. We examined the trend in timing of outpatient palliative-care referrals over a 10-year period in patients with haematologic malignancies at our comprehensive cancer centre. We included consecutive patients with a diagnosis of haematologic malignancy who were seen at our outpatient palliative-care clinic between 1 January 2010 and 31 December 2019. We collected data on patient characteristics, symptom burden and supportive-care interventions at outpatient palliative-care consultation. The primary outcome was time from outpatient palliative-care consultation to death or last follow-up. In all, 384 patients were referred by leukaemia (n = 143), lymphoma (n = 213), and stem cell transplant (n = 28) services. The median time from outpatient palliative-care referral to death was 3.4 years (IQR 2.4-5.3) with a significant increase in both the number of referrals per year (p = 0.047) and the timing of referral between 2010 and 2019 (p = 0.001). Patients with haematologic malignancies were referred in a timely fashion to our outpatient palliative-care clinic, with earlier and greater numbers of referrals over time.
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Affiliation(s)
- Sameer Patel
- Department of Palliative Care, Rochester General Hospital, Rochester, New York, USA
| | - Geordyn Hoge
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Bryan Fellman
- Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas, USA
| | - Sharanpreet Kaur
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Yvonne Heung
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, Texas, USA
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8
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Ehrman S, Lockwood B, Russell D, Bickley M, Myers S, Radwany S. Impact of Referring Team Characteristics on Inpatient Palliative Care Consultation Rate at a Comprehensive Cancer Center. J Palliat Med 2022; 25:1413-1417. [PMID: 35587787 DOI: 10.1089/jpm.2022.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: No prior study addresses the impact of admitting team characteristics on inpatient palliative care (PC) consultation rate in cancer patients. Understanding consultation rate differences among admitting service types may reveal PC access disparities for patients who would benefit from consultation. Aim: To determine the impact of admitting service characteristics (teaching vs. nonteaching and surgical vs. medical) on inpatient PC consultation rates. Methods: A six-month cross-sectional study was performed at an academic comprehensive cancer center. Inpatient PC consultations and follow-up visits were compared to total admissions by admitting service category. Results: Five thousand six hundred ninety-seven admissions resulted in 710 new PC consultations and 2494 follow-up visits. Patients admitted to medical services had highest odds of PC consultation, while data for teaching services were mixed. There was no difference in follow-up visits. Conclusions: Significant differences between medical and surgical service PC consultation rates may indicate specialty PC access disparities solely based on their admitting service.
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Affiliation(s)
- Sarah Ehrman
- Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Bethany Lockwood
- Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Deborah Russell
- Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Mary Bickley
- Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Stephanie Myers
- Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Steven Radwany
- Division of Palliative Medicine, The Ohio State University, Columbus, Ohio, USA
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9
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Sedhom R, Blackford AL, Gupta A, Smith TJ, Shulman LN, Carducci MA. Oncologist Peer Comparisons as a Behavioral Science Strategy to Improve Hospice Utilization. JCO Oncol Pract 2022; 18:e1122-e1131. [PMID: 35377734 DOI: 10.1200/op.21.00738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Hospice utilization metrics are essential for any serious effort to improve end-of-life care in oncology. However, oncologists do not routinely receive these personalized reports. We evaluated whether a behavioral science intervention, using peer comparisons coupled with social norms, was associated with improvements in hospice use. METHODS Oncologists at two academic practices of Johns Hopkins Medicine were randomly assigned to receive a peer comparison report by e-mail displaying individual hospice utilization metrics compared with top-performing peers or to receive no report. The data accrued for the intervention represented hospice utilization for the previous calendar year. The intervention period was from June 1, 2020, to December 30, 2020, and included oncologists from both the solid and hematologic malignancies programs. The primary outcome was the proportion of patients between groups with short hospice length of stay (LOS; defined as ≤ 7 days) after 6 months. Secondary outcomes included hospice referral rate, enrollment rate, and median LOS. RESULTS Forty-seven oncologists participated. The percent of patients with a short hospice stay in the intervention group was lower (17.4%) compared with patients treated by physicians in the usual care group (46.3%, difference = 21.8%; 95% CI, 16.0 to 41.6; P < .001). Receipt of peer comparisons was associated with a greater likelihood of enrolling in hospice (73.7% v 42.8%; difference = 31.1%; 95% CI, 20.4 to 41.7; P < .001) and a longer hospice LOS (37.2 v 18.3 days; difference = 17.2; 95% CI, 8.8 to 25.7 days; P < .001). CONCLUSION Peer comparisons improved hospice utilization metrics among a group of academic oncologists. Behavioral science offers one pragmatic strategy to overcome suboptimal oncologist decision-making biases related to hospice use.
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Affiliation(s)
- Ramy Sedhom
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.,Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA
| | - Amanda L Blackford
- Division of Biostatistics and Bioinformatics, Department of Oncology, Johns Hopkins University, Baltimore, MD
| | - Arjun Gupta
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN
| | - Thomas J Smith
- Section of Palliative Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore MD
| | - Lawrence N Shulman
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA
| | - Michael A Carducci
- Section of Palliative Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore MD
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10
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Temel JS, Petrillo LA, Greer JA. Patient-Centered Palliative Care for Patients With Advanced Lung Cancer. J Clin Oncol 2022; 40:626-634. [PMID: 34985932 DOI: 10.1200/jco.21.01710] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The evidence base demonstrating the benefits of an early focus on palliative care for patients with serious cancers, including advanced lung cancer, is substantial. Early involvement of specialty-trained palliative care clinicians in the care of patients with advanced lung cancer improves patient-reported outcomes, such as quality of life, and health care delivery, including hospice utilization. Since the time that many of these palliative care trials were conducted, the paradigm of cancer care for many cancers, including lung cancer, has changed dramatically. The majority of patients with advanced lung cancer are now treated with immune checkpoint inhibitors or targeted therapies, both of which have had a significant impact on patient's experience and outcomes. With this changing landscape of lung cancer therapeutics, patients are facing new and different challenges, including dealing with novel side effect profiles and coping with greater uncertainty regarding their prognosis. Patients who are living longer with their advanced cancer also struggle with how to address survivorship issues, such as sexual health and exercise, and decision making about end-of-life care. Although palliative care clinicians remain well-suited to address these care needs, they may need to learn new skills to support patients treated with novel therapies. Additionally, as the experience of patients with advanced lung cancer is becoming more varied and individualized, palliative care research interventions and clinical programs should also be delivered in a patient-centered manner to best meet patient's needs and improve their outcomes. Tailored and technology-based palliative care interventions are promising strategies for delivering patient-centered palliative care.
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Affiliation(s)
- Jennifer S Temel
- Harvard Medical School, Boston, MA.,Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Laura A Petrillo
- Harvard Medical School, Boston, MA.,Division of Palliative Care, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Joseph A Greer
- Harvard Medical School, Boston, MA.,Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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11
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Timely Palliative Care: Personalizing the Process of Referral. Cancers (Basel) 2022; 14:cancers14041047. [PMID: 35205793 PMCID: PMC8870673 DOI: 10.3390/cancers14041047] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/13/2022] [Accepted: 02/15/2022] [Indexed: 02/01/2023] Open
Abstract
Timely palliative care is a systematic process to identify patients with high supportive care needs and to refer these individuals to specialist palliative care in a timely manner based on standardized referral criteria. It requires four components: (1) routine screening of supportive care needs at oncology clinics, (2) establishment of institution-specific consensual criteria for referral, (3) a system in place to trigger a referral when patients meet criteria, and (4) availability of outpatient palliative care resources to deliver personalized, timely patient-centered care aimed at improving patient and caregiver outcomes. In this review, we discuss the conceptual underpinnings, rationale, barriers and facilitators for timely palliative care referral. Timely palliative care provides a more rational use of the scarce palliative care resource and maximizes the impact on patients who are offered the intervention. Several sets of referral criteria have been proposed to date for outpatient palliative care referral. Studies examining the use of these referral criteria consistently found that timely palliative care can lead to a greater number of referrals and earlier palliative care access than routine referral. Implementation of timely palliative care at each institution requires oncology leadership support, adequate palliative care infrastructure, integration of electronic health record and customization of referral criteria.
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Jairam V, Yang DX, Pasha S, Soulos PR, Gross CP, Yu JB, Park HS. Temporal Trends in Opioid Prescribing Patterns Among Oncologists in the Medicare Population. J Natl Cancer Inst 2021; 113:274-281. [PMID: 32785685 DOI: 10.1093/jnci/djaa110] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/05/2020] [Accepted: 06/11/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In the wake of the US opioid epidemic, there have been efforts to curb opioid prescribing. However, it is unknown whether these efforts have affected prescribing among oncologists, whose patients often require opioids for symptom management. We investigated temporal patterns in opioid prescribing for Medicare beneficiaries among oncologists and nononcologists. METHODS We queried the Centers for Medicare and Medicaid Services Part D prescriber dataset for all physicians between January 1, 2013, and December 31, 2017. We used population-averaged multivariable negative binomial regression to estimate the association between time and per-provider opioid and gabapentinoid prescribing rate, defined as the annual number of drug claims (original prescriptions and refills) per beneficiary, among oncologists and nononcologists on a national and state level. RESULTS From 2013 to 2017, the national opioid-prescribing rate declined by 20.7% (P < .001) among oncologists and 22.8% (P < .001) among non oncologists. During this time frame, prescribing of gabapentin increased by 5.9% (P < .001) and 23.1% (P < .001) among oncologists and nononcologists, respectively. Among palliative care providers, opioid prescribe increased by 15.3% (P < .001). During the 5-year period, 43 states experienced a decrease (P < .05) in opioid prescribing among oncologists, and in 5 states, opioid prescribing decreased more among oncologists than nononcologists (P < .05). CONCLUSIONS Between 2013 and 2017, the opioid-prescribing rate statistically significantly decreased nationwide among oncologists and nononcologists, respectively. Given similar declines in opioid prescribing among oncologists and nononcologists, there is concern that opioid-prescribing guidelines intended for the noncancer population are being applied inappropriately to patients with cancer and cancer survivors.
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Affiliation(s)
- Vikram Jairam
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Daniel X Yang
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Saamir Pasha
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School, New Haven, CT, USA
| | - Pamela R Soulos
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School, New Haven, CT, USA
| | - Cary P Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School, New Haven, CT, USA.,Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,National Clinician Scholars Program, Yale University School of Medicine, New Haven, CT, USA
| | - James B Yu
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School, New Haven, CT, USA
| | - Henry S Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School, New Haven, CT, USA
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Kim YJ, Hiratsuka Y, Suh SY, Kang B, Lee SW, Ahn HY, Suh KJ, Kim JW, Kim SH, Kim JW, Lee KW, Kim JH, Lee JS. A Prognostic Model to Facilitate Palliative Care Referral in Oncology Outpatients. Cancer Res Treat 2021; 54:621-629. [PMID: 34265891 PMCID: PMC9016316 DOI: 10.4143/crt.2021.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/10/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose We aimed to develop a prognostic model to assist palliative care referral at least 3 months before death in advanced cancer patients treated at an outpatient medical oncology clinic. Materials and Methods In this prospective cohort study, a total of 200 patients were enrolled at a tertiary cancer center in South Korea. The major eligibility criterion was an expected survival of less than a year as estimated by their oncologists. We analyzed the influences of known prognostic factors along with chemotherapy status, mid-arm circumference, and triceps skinfold thickness on survival time. Results The mean age of the patients was 64.5 years, 36% were female, and the median survival time was 7.6 months. In the multivariate analysis, we found six significant factors related to poor survival: a poor Eastern Cooperative Oncology Group (ECOG) performance status (≥ 2), not undergoing chemotherapy, anorexia, a low lymphocyte level (< 12%), a high lactate dehydrogenase (LDH) level (≥ 300 IU/L), and a low mid-arm circumference (< 23 cm). We developed a prognostic model (score, 0–8.0) to predict 3-month survival based on the multivariate analysis. Patients who scored ≥ 4.0 points had a short survival of less than 3 months (p < 0.001). The discriminating ability of the prognostic model using the area under the receiver operating characteristic curve was 0.88. Conclusion The prognostic model using ECOG performance status, chemotherapy status, anorexia, lymphocytes, LDH, and mid-arm circumference can predict 3-month survival in medical oncology outpatients. It can alert oncologists to refer patients to palliative care specialists before it is too late.
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Affiliation(s)
- Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Sang-Yeon Suh
- Hospice & Palliative Care Center, Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.,Department of Medicine, Dongguk University Medical School, Seoul, Korea
| | - Beodeul Kang
- Division of Medical Oncology, Bundang Medical Center, CHA University, Seongnam, Korea
| | - Si Won Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Yonsei Cancer Center, Seoul, Korea
| | - Hong-Yup Ahn
- Department of Statistics, Dongguk University Medical School, Seoul, Korea
| | - Koung Jin Suh
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji-Won Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Se Hyun Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin Won Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Keun-Wook Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jee Hyun Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong Seok Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Hui D, De La Rosa A, Chen J, Guay MD, Heung Y, Dibaj S, Liu D, Bruera E. Palliative care education and research at US cancer centers: A national survey. Cancer 2021; 127:2139-2147. [PMID: 33662148 PMCID: PMC11317990 DOI: 10.1002/cncr.33474] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/14/2020] [Accepted: 07/05/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Palliative care (PC) education and research are essential to developing a skilled workforce and evidence base to support the delivery of quality cancer care. The current state of PC education and research at US cancer centers is unclear. In this national survey, the education and research programs of the National Cancer Institute (NCI)-designated and nondesignated cancer centers and the changes between 2009 and 2018 are compared. METHODS Between April and August 2018, PC program leaders at all NCI-designated cancer centers and a random sample of nondesignated centers were sent a survey to examine the structure, processes, and outcomes of their programs on the basis of questions from a 2009 national survey. This preplanned analysis focused on education and research. RESULTS There were 52 of 61 (85%) NCI-designated and 27 of 38 (71%) nondesignated cancer centers that responded. NCI-designated centers were more likely than nondesignated centers to have a PC fellowship program (87% vs 30%; P < .001), training for advanced practice providers (71% vs 44%; P = .03), PC research program (58% vs 15%; P < .001), peer-reviewed funding (43% vs 11%; P = .005), and philanthropic grants (41% vs 7%; P = .002). There were few significant improvements in PC education or research between 2009 and 2018 for both groups, notable exceptions include an increase in PC fellowships (38% vs 87%; P < .001) and mandatory PC rotations for medical oncology fellows (29% vs 55%; P = .02) at NCI-designated cancer centers. CONCLUSIONS PC education and research are more developed at NCI-designated cancer centers. Despite some progress over the past decade, it is relatively slow and suboptimal.
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Affiliation(s)
- David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Allison De La Rosa
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph Chen
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marvin Delgado Guay
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yvonne Heung
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Seyedeh Dibaj
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diane Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Hui D, Anderson L, Tang M, Park M, Liu D, Bruera E. Examination of referral criteria for outpatient palliative care among patients with advanced cancer. Support Care Cancer 2020; 28:295-301. [PMID: 31044305 PMCID: PMC6824973 DOI: 10.1007/s00520-019-04811-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 04/07/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND An international panel achieved consensus on 9 need-based and 2 time-based major referral criteria to identify patients appropriate for outpatient palliative care referral. To better understand the operational characteristics of these criteria, we examined the proportion and timing of patients who met these referral criteria at our Supportive Care Clinic. METHODS We retrieved data on consecutive patients with advanced cancer who were referred to our Supportive Care Clinic between January 1, 2016, and February 18, 2016. We examined the proportion of patients who met each major criteria and its timing. RESULTS Among 200 patients (mean age 60, 53% female), the median overall survival from outpatient palliative care referral was 14 (95% confidence interval 9.2, 17.5) months. A majority (n = 170, 85%) of patients met at least 1 major criteria; specifically, 28%, 30%, 20%, and 8% met 1, 2, 3, and ≥ 4 criteria, respectively. The most commonly met need-based criteria were severe physical symptoms (n = 140, 70%), emotional symptoms (n = 36, 18%), decision-making needs (n = 26, 13%), and brain/leptomeningeal metastases (n = 25, 13%). For time-based criteria, 54 (27%) were referred within 3 months of diagnosis of advanced cancer and 63 (32%) after progression from ≥ 2 lines of palliative systemic therapy. The median duration from patient first meeting any criterion to palliative care referral was 2.4 (interquartile range 0.1, 8.6) months. CONCLUSIONS Patients were referred early to our palliative care clinic and a vast majority (85%) of them met at least one major criteria. Standardized referral based on these criteria may facilitate even earlier referral.
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Affiliation(s)
- David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
| | - Laurie Anderson
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Michael Tang
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Minjeong Park
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diane Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
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Caraceni A, Lo Dico S, Zecca E, Brunelli C, Bracchi P, Mariani L, Garassino MC, Vitali M. Outpatient palliative care and thoracic medical oncology: Referral criteria and clinical care pathways. Lung Cancer 2019; 139:13-17. [PMID: 31704278 DOI: 10.1016/j.lungcan.2019.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/05/2019] [Accepted: 10/05/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Recent evidences show that early integration of palliative care (PC) with oncology has a positive impact on patients' quality of life, quality of care and costs. However, there is no consensus on outpatient referral criteria. Based on real world data, the aim of this study was to identify timing and factors associated to PC referral in patients with thoracic malignancies, and to describe their clinical care pathway. MATERIAL AND METHODS This observational retrospective study included consecutive patients with thoracic cancer, seen for the first time at the Thoracic Medical Oncology outpatient Clinic (TMOC) of our institution, between Jan.01-Dec.31 2014. Patients were followed-up till death or Dec.31 2015. Clinical and demographic data were collected from the electronic patient records. Cox regression models were used to evaluate the association between time to Palliative care Outpatient Clinic (POC) referral and performance status (PS), disease stage and symptoms at inclusion. RESULTS 229 patients were eligible. 98 of them (43%; 95%IC 36%-49%) were referred to the POC within a median of 30 days (IQR 4-188). 80/98 patients received simultaneous anticancer therapy and PC. Univariable analysis showed that the hazard ratio (HR) of being referred to POC was significantly higher for patients with worse PS (HR = 4.5), more advanced disease stage (HR = 3.1), pain (HR = 4.9), dyspnea (HR = 2.5) and cough (HR = 2.2). The multivariable model confirmed independent prognostic value for PS, disease stage and pain. On Dec.31, 2015, 25/98 patients were still alive, 8 were lost at follow up and 65 had died. Among the latter, 61% died with hospice or home care, and, in the last 30 days of life, 16% received chemotherapy and 29% were admitted to hospital. CONCLUSIONS Our results suggest considering symptom burden, PS and disease stage as screening criteria for referral to PC in patients with thoracic malignancies.
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Affiliation(s)
- Augusto Caraceni
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - Silvia Lo Dico
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - Ernesto Zecca
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy; European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Paola Bracchi
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marina C Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Milena Vitali
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Abstract
OPINION STATEMENT Multiple randomized controlled trials have underscored the importance of timely referral to palliative care for patients with advanced cancer. Outpatient palliative care can facilitate timely referral and is increasingly available in many cancer centers. The key question is which model of outpatient palliative care is optimal. There are currently many variations for how palliative care is delivered in the outpatient setting, including (1) Interdisciplinary Specialist Palliative Care in Stand-Alone Clinics, (2) Physician-Only Specialist Palliative Care in Stand-Alone Clinics, (3) Nurse-Led Specialist Palliative Care in Stand-Alone Clinics, (4) Nurse-Led Specialist Palliative Care Telephone-Based Interventions, (5) Embedded Specialist Palliative Care with Variable Team Makeup, and (6) Advanced Practice Providers-Based Enhanced Primary Palliative Care. It is important to make a clear distinction among these delivery models of outpatient palliative care because they have different structures, processes, and outcomes, along with unique strengths and limitations. In this review article, we will provide a critical appraisal of the literature on studies investigating these models. At this time, interdisciplinary specialist palliative care in stand-alone clinics remains the gold standard for ambulatory palliative care because this approach has the greatest impact on multiple patient and caregiver outcomes. Although the other models may require fewer resources, they may not be able to provide the same level of comprehensive palliative care as an interdisciplinary team. Further research is needed to evaluate the optimal model of palliative care delivery in different settings.
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Affiliation(s)
- David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Unit 1414 - 1515 Holcombe Blvd., Houston, TX, 77030, USA. .,Department of General Oncology, MD Anderson Cancer Center, Houston, TX, USA.
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