Impact of early palliative care on survival in advanced-stage cancer patients: An institution-based retrospective cross-sectional study

Abstract

Background: While treating patients with the advanced disease it becomes very challenging for the clinicians to decide as to when the active treatment is justified and when should palliative care be introduced in patient's treatment. American Society of Clinical Oncology (ASCO) suggested that patients with advanced cancer, regardless of patient or outpatient, should receive dedicated palliative care services, early in the disease course, simultaneous with active treatment. Similar recommendations have been proposed by the European Society of Medical Oncology (ESMO). Keeping in view this background, we aimed to do this study. Aim: To study the impact of the introduction of early palliative care into routine oncological management on patient's survival. Methods: This retrospective cross-sectional study is based on hospital data for patients who died in the hospice between the year 2017 and 2018. The complete information including age, gender, date of death, diagnosis, procedures, and medical interventions, as well as the date of documentation, was obtained of each patient. Results: A total of 27 patients were enrolled in this study. The mean age at presentation was 50.3 years. 11 (40.7%) patients received oncological treatment integrated with palliative care in the last month of life. The median duration of survival from diagnosis till death was 7 months in the patients who received only palliative care and 10 months in patients who received integrated onco-palliative care in the last month of life (P=0.452). 14 (51.8%) patients received early palliative care. The median survival of the patients who received early palliative care and of those who were offered palliative care towards the end of life was 8.5 months and 7 months respectively (P=0.040). Conclusion: Based on our results, we strongly believe that early palliative care when integrated into standard oncological treatment in advance stage cancer patients can prolong patient's survival. serious treatment measures notwithstanding when the prognosis is dismal [1][2]. A definitive objective of palliative care is to improve quality of life for both the patient and the family, regardless of diagnosis.Earle et al. characterized specific clinical quality indicators for overtreatment, incorrect treatment, and undertreatment during the end of the life [3]. The indicators distinguished were: 1) receiving chemotherapy in the last 14 days of life and/or start of chemotherapy during the last 30 days of life (overtreatment); 2) more than one emergency hospital admission and/or intensive-care unit admission during the last month of life (incorrect treatment); 3) involvement of hospice and/or specialized palliative services less than 3 days before death

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