Is palliative care support associated with better quality end-of-life care indicators for patients with advanced cancer? A retrospective cohort study

Abstract

ObjectivesThis study aimed to establish the association between timing and provision of palliative care (PC) and quality of end-of-life care indicators in a population of patients dying of cancer.SettingThis study uses linked cancer patient data from the National Cancer Registry, the electronic medical record system used in primary care (SystmOne) and the electronic medical record system used within a specialist regional cancer centre. The population resided in a single city in Northern England.ParticipantsRetrospective data from 2479 adult cancer decedents who died between January 2010 and February 2012 were registered with a primary care provider using the SystmOne electronic health record system, and cancer was certified as a cause of death, were included in the study.ResultsLinkage yielded data on 2479 cancer decedents, with 64.5% who received at least one PC event. Decedents who received PC were significantly more likely to die in a hospice (39.4% vs 14.5%, P<0.005) and less likely to die in hospital (23.3% vs 40.1%, P<0.05), and were more likely to receive an opioid (53% vs 25.2%, P<0.001). PC initiated more than 2 weeks before death was associated with avoiding a hospital death (≥2 weeks, P<0.001), more than 4 weeks before death was associated with avoiding emergency hospital admissions and increased access to an opioid (≥4 weeks, P<0.001), and more than 33 weeks before death was associated with avoiding late chemotherapy (≥33 weeks, no chemotherapy P=0.019, chemotherapy over 4 weeks P=0.007).ConclusionFor decedents with advanced cancer, access to PC and longer duration of PC were significantly associated with better end-of-life quality indicators.

Cancer patients as frequent attenders in emergency departments: A national cohort study

“…One limitation was that we could not link our data to the various independent home hospice organizations in Singapore; hence, we could not examine the effect of timely referral and frequency of home hospice visits on ED utilization, shown to reduce ED utilization . The majority of dying cancer patients in Singapore receive community hospice services, and the high‐risk groups we found in our study may benefit from the early referral.…”

Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care

“…Palliative care involvement was associated with less aggressive care, as measured by the use of chemotherapy near death (odds ratio [OR], 0.34), intensive care unit admissions (OR, 0.12), emergency room visits (OR, 0.19), and hospitalizations near death (OR, 0.24); moreover, earlier palliative care was associated with better outcomes . Studies from Italy and the United Kingdom examining the effect of palliative care confirmed similar benefits with earlier referral …”

“…The optimal timing of specialist palliative care referral remains unclear but likely depends on the individual patient and the health care system. In addition to a meta‐analysis suggesting that earlier referral was associated with a greater benefit, several nonrandomized studies have also demonstrated the impact of timely palliative care on aggressiveness of care at the end of life . In a retrospective cohort study, patients who were referred to a comprehensive cancer center more than 6 months before death were compared with those who were referred 6 months or less before death.…”

“…In addition to a meta-analysis suggesting that earlier referral was associated with a greater benefit, 46 several nonrandomized studies have also demonstrated the impact of timely palliative care on aggressiveness of care at the end of life. 59,[64][65][66] In a retrospective cohort study, patients who were referred to a comprehensive cancer center more than 6 months before death were compared with those who were referred 6 months or less before death. Earlier referrals were associated with significantly better outcomes in the last 30 days of life, with lower rates of emergency room visits (41% vs 63%; P = .002) and hospitalizations (51% vs 75%; P < .001).…”

How do patients with cancer pain view community pharmacy services? An interview study

“…This is supported by the Voices survey where only 18% of patients in community settings were likely to describe their pain as being completely controlled compared with 38% in hospital and 68% in hospice environments (VOICES National Survey of Bereaved People, ). Referral to palliative care is known to happen relatively late in the journey of a terminal cancer patient and one‐third of patients who die from cancer never receive specialist palliative care services (Ziegler et al., ). The idea of resilience of the patient to cope with problems has been found in other disease areas, not just palliative care (Fylan, Armitage, Naylor, & Blenkinsopp, ).…”