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Tuca A, Viladot M, Carrera G, Llavata L, Barrera C, Chicote M, Marco-Hernández J, Padrosa J, Zamora-Martínez C, Grafia I, Pascual A, Font C, Font E. Evolution of Complexity of Palliative Care Needs and Patient Profiles According to the PALCOM Scale (Part Two): Pooled Analysis of the Cohorts for the Development and Validation of the PALCOM Scale in Advanced Cancer Patients. Cancers (Basel) 2024; 16:1744. [PMID: 38730696 PMCID: PMC11083064 DOI: 10.3390/cancers16091744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/19/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Identifying the complexity of palliative care needs is a key aspect of referral to specialized multidisciplinary early palliative care (EPC) teams. The PALCOM scale is an instrument consisting of five multidimensional assessment domains developed in 2018 and validated in 2023 to identify the level of complexity in patients with advanced cancer. (1) Objectives: The main objective of this study was to determine the degree of instability (likelihood of level change or death), health resource consumption and the survival of patients according to the level of palliative complexity assigned at the baseline visit during a 6-month follow-up. (2) Method: An observational, prospective, multicenter study was conducted using pooled data from the development and validation cohort of the PALCOM scale. The main outcome variables were as follows: (a) instability ratio (IR), defined as the probability of level change or death; (b) emergency department visits; (c) days of hospitalization; (d) hospital death; (e) survival. All the variables were analyzed monthly according to the level of complexity assigned at the baseline visit. (3) Results: A total of 607 patients with advanced cancer were enrolled. According to the PALCOM scale, 20% of patients were classified as low complexity, 50% as medium and 30% as high complexity. The overall IR was 45% in the low complexity group, 68% in the medium complexity group and 78% in the high complexity group (p < 0.001). No significant differences in mean monthly emergency department visits (0.2 visits/ patient/month) were observed between the different levels of complexity. The mean number of days spent in hospital per month was 1.5 in the low complexity group, 1.8 in the medium complexity group and 3.2 in the high complexity group (p < 0.001). The likelihood of in-hospital death was significantly higher in the high complexity group (29%) compared to the medium (16%) and low (8%) complexity groups (p < 0.001). Six-month survival was significantly lower in the high complexity group (24%) compared to the medium (37%) and low (57%) complexity groups (p < 0.001). CONCLUSION According to the PALCOM scale, more complex cases are associated with greater instability and use of hospital resources and lower survival. The data also confirm that the PALCOM scale is a consistent and useful tool for describing complexity profiles, targeting referrals to the EPC and managing the intensity of shared care.
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Affiliation(s)
- Albert Tuca
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
- Psychosocial Support Team, “La Caixa” Foundation (EAPS), Clinic Hospital of Barcelona, 08036 Barcelona, Spain
- Chair of Palliative Care, University of Barcelona, 08036 Barcelona, Spain
| | - Margarita Viladot
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
| | - Gemma Carrera
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
| | - Lucia Llavata
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
| | - Carmen Barrera
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
- Chair of Palliative Care, University of Barcelona, 08036 Barcelona, Spain
| | - Manoli Chicote
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
| | - Javier Marco-Hernández
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
| | - Joan Padrosa
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
| | - Carles Zamora-Martínez
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
| | - Ignacio Grafia
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
| | - Anais Pascual
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
- Psychosocial Support Team, “La Caixa” Foundation (EAPS), Clinic Hospital of Barcelona, 08036 Barcelona, Spain
| | - Carme Font
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
| | - Elena Font
- Unit of Supportive Care in Cancer, Medical Oncology Department, Hospital Clinic and Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (G.C.); (L.L.); (C.B.); (M.C.); (J.M.-H.); (J.P.); (C.Z.-M.); (I.G.); (A.P.); (C.F.); (E.F.)
- Psychosocial Support Team, “La Caixa” Foundation (EAPS), Clinic Hospital of Barcelona, 08036 Barcelona, Spain
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Viladot M, Gallardo-Martínez JL, Hernandez-Rodríguez F, Izcara-Cobo J, Majó-LLopart J, Peguera-Carré M, Russinyol-Fonte G, Saavedra-Cruz K, Barrera C, Chicote M, Barreto TD, Carrera G, Cimerman J, Font E, Grafia I, Llavata L, Marco-Hernandez J, Padrosa J, Pascual A, Quera D, Zamora-Martínez C, Bozzone AM, Font C, Tuca A. Validation Study of the PALCOM Scale of Complexity of Palliative Care Needs: A Cohort Study in Advanced Cancer Patients. Cancers (Basel) 2023; 15:4182. [PMID: 37627210 PMCID: PMC10453100 DOI: 10.3390/cancers15164182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/04/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND In a patient-centred model of care, referral to early palliative care (EPC) depends on both the prognosis and the complexity of care needs. The PALCOM scale is a 5-domain multidimensional assessment tool developed to identify the level of complexity of palliative care needs of cancer patients. The aim of this study was to validate the PALCOM scale. PATIENT AND METHODS We conducted a prospective cohort study of cancer patients to compare the PALCOM scale and expert empirical assessment (EA) of the complexity of palliative care needs. The EA had to categorise patients according to their complexity, considering that medium to high levels required priority attention from specialist EPC teams, while those with low levels could be managed by non-specialist teams. Systematically collected multidimensional variables were recorded in an electronic report form and stratified by level of complexity and rating system (PALCOM scale versus EA). The correlation rank (Kendall's tau test) and accuracy test (F1-score) between the two rating systems were analysed. ROC curve analysis was used to determine the predictive power of the PALCOM scale. RESULTS A total of 283 advanced cancer patients were included. There were no significant differences in the frequency of the levels of complexity between the EA and the PALCOM scale (low 22.3-23.7%; medium 57.2-59.0%; high 20.5-17.3%). The prevalence of high symptom burden, severe pain, functional impairment, socio-familial risk, existential/spiritual problems, 6-month mortality and in-hospital death was significantly higher (p < 0.001) at the high complexity levels in both scoring systems. Comparative analysis showed a high correlation rank and accuracy between the two scoring systems (Kendall's tau test 0.81, F1 score 0.84). The predictive ability of the PALCOM scale was confirmed by an area under the curve in the ROC analysis of 0.907 for high and 0.902 for low complexity. CONCLUSIONS In a patient-centred care model, the identification of complexity is a key point to appropriate referral and management of shared care with EPC teams. The PALCOM scale is a high precision tool for determining the level of complexity of palliative care needs.
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Affiliation(s)
- Margarita Viladot
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Jose-Luís Gallardo-Martínez
- Home Care Support Teams Program (PADES) Group Mutuam, 08025 Barcelona, Spain; (J.-L.G.-M.); (J.I.-C.); (M.P.-C.); (K.S.-C.)
| | | | - Jessica Izcara-Cobo
- Home Care Support Teams Program (PADES) Group Mutuam, 08025 Barcelona, Spain; (J.-L.G.-M.); (J.I.-C.); (M.P.-C.); (K.S.-C.)
| | | | - Marta Peguera-Carré
- Home Care Support Teams Program (PADES) Group Mutuam, 08025 Barcelona, Spain; (J.-L.G.-M.); (J.I.-C.); (M.P.-C.); (K.S.-C.)
| | - Giselle Russinyol-Fonte
- Mutuam Güell Social Health Care Hospital, 08024 Barcelona, Spain; (F.H.-R.); (G.R.-F.); (D.Q.)
| | - Katia Saavedra-Cruz
- Home Care Support Teams Program (PADES) Group Mutuam, 08025 Barcelona, Spain; (J.-L.G.-M.); (J.I.-C.); (M.P.-C.); (K.S.-C.)
| | - Carmen Barrera
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Manoli Chicote
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Tanny-Daniela Barreto
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Gemma Carrera
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Jackeline Cimerman
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Elena Font
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
- Psychosocial Support Team, “La Caixa” Foundation (EAPS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Ignacio Grafia
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Lucia Llavata
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Javier Marco-Hernandez
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Joan Padrosa
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Anais Pascual
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
- Psychosocial Support Team, “La Caixa” Foundation (EAPS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Dolors Quera
- Mutuam Güell Social Health Care Hospital, 08024 Barcelona, Spain; (F.H.-R.); (G.R.-F.); (D.Q.)
| | - Carles Zamora-Martínez
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | | | - Carme Font
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Albert Tuca
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
- Psychosocial Support Team, “La Caixa” Foundation (EAPS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain
- Chair of Palliative Care, University of Barcelona, 08036 Barcelona, Spain
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