This study analyzed palliative/supportive care use in a single cancer center over 8 years. Billing data showed the inpatient consultations as a percentage of hospital admissions and the ratio of inpatient consultations to hospital beds almost doubled. In the outpatient setting, data revealed earlier access to outpatient referrals to palliative care service (from 4.8 months to 7.9 months; p = .001) during the study period.

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Background: The present study evaluated the effect of phenolic aqueous leaf extract of Vitex doniana on body weight, serum glucose and oxidative stress parameters in diabetes mellitus (DM) rats. Methods: DM was induced in rats by intraperitoneal injection of 100 mg/kg alloxan monohydrate in phosphate buffered saline (PBS; pH = 7.4). A total of 36 adult male Wister albino rats were divided into 6 groups of 6 rats. The groups consist of normal untreated rats, untreated DM rats, DM rats treated with 500 mg/kg dimethylguanide (MetforminTM) and DM rats treated with 100, 200 and 400 mg/kg body weight of phenolic aqueous leaf extract of Vitex doniana. The rats were treated for 28 days. Serum glucose, malondialdehyde (MDA), glutathione (GSH) and ascorbic acid concentrations, and serum superoxide dismutase (SOD) and catalase (CAT) activities were measured using standard methods. The changes in body weight was also measured. Results: The results showed a significant reduction (p < 0.05) in serum glucose and MDA concentration, whereas serum SOD, CAT activities, as well as GSH and ascorbic acid concentration were significantly elevated (p < 0.05) in treated DM groups in a dose dependent manner. Conclusion: The results of the present study indicated that phenolic aqueous leaf extract of V. doniana promoted increased body weight, ameliorated DM and alleviated reduced antioxidant activities in alloxan-induced DM rats. Phenolic aqueous leaf extract of V. doniana could serve as a potential natural and safe remedy for the management of DM.

10 Background: We have previously shown the name “palliative” to be a barrier to early palliative care (PC) referral. Further, following service name change to supportive care (SC) in late 2007, we immediately observed an increased survival time of about 1.5 months from PC consultation suggesting earlier referral following the name change. This study was conducted to determine the timing of patient access to outpatient PC services over several years period after the name change. Methods: Records of consecutive outpatient referrals in fiscal years (FY) 2007 (pre-name change), 2008 (transition period), 2009-2013 (post-name change) were reviewed. Timing of PC access was determined by 3 time intervals: (a) survival from PC consultation; (b) advanced cancer diagnosis to PC (c) hospital registration to PC; Kruskal-Wallis, Kaplan Meir and Cox regression models were used. Results: 6,624 patients had their first outpatient PC consultation during FY 2007 to 2013. Each year we observed a consistent increase in new patient referrals, as well as a longer median survival time from PC consultation (logrank <0.0001). The table below shows median survival and hazard ratio (HR) for FYs 2008-2013 as compared to FY 2007. In FY 2013 there were 63% greater number of outpatient referrals as compared to FY 2007 (p <0.0001), longer median survival (months) (7.9 vs 4.8; p <0.001), and shorter median interval (months) from advanced cancer diagnosis (5.9 vs 7.8; p< 0.002) and from hospital registration (6.6 vs 14.8; p< 0.0001) to PC consultation. Conclusions: Following the name change of service from PC to SC, there has been consistent annual increase in new patient referrals as well as earlier access to outpatient PC services. The outpatient setting facilitates earlier patient access to SC/PC services and should be established in more centers. [Table: see text]