Palliative care referral criteria and outcomes in cancer and heart failure: a systematic review of literature

Abstract

Background Cardiotoxicity resulting in heart failure (HF) is among the most dreaded complications of cancer therapy and can significantly impact morbidity and mortality. Leading professional societies in cardiology and oncology recommend improved access to hospice and palliative care (PC) for patients with cancer and advanced HF. However, there is a paucity of published literature on the use of PC in cardio-oncology, particularly in patients with HF and a concurrent diagnosis of cancer. Aims To identify existing criteria for referral to and early integration of PC in the management of cases of patients with cancer and patients with HF, and to identify assessments of outcomes of PC intervention that overlap between patients with cancer and patients with HF. Design Systematic literature review on PC in patients with HF and in patients with cancer. Data sources Databases including Ovid Medline, Ovid Embase, Cochrane Library, and Web of Science from January 2009 to September 2020. Results Sixteen studies of PC in cancer and 14 studies of PC in HF were identified after screening of the 8647 retrieved citations. Cancer and HF share similarities in their patient-reported symptoms, quality of life, symptom burden, social support needs, readmission rates, and mortality. Conclusion The literature supports the integration of PC into oncology and cardiology practices, which has shown significant benefit to patients, caregivers, and the healthcare system alike. Incorporating PC in cardio-oncology, particularly in the management of HF in patients with cancer, as early as at diagnosis, will enable patients, family members, and healthcare professionals to make informed decisions about various treatments and end-of-life care and provide an opportunity for patients to participate in the decisions about how they will spend their final days.

Quality of referrals to specialist palliative care and remote patient triage — a cross-sectional study

“…Despite the fact that primary care physicians, in most situations, should be the crucial providers of palliative care in communities, local partnerships with palliative centres are strongly recommended [12]. Generalists should cooperate with specialist outpatient palliative care at least within a consultation model, when consultants do not need to take over all aspects of care [40]. What is more, the whole health care system should also facilitate primary care development, with adequate resources and financial incentives to support education as well as collaboration within the interdisciplinary teams [41].…”

Quality of Referrals to Specialist Palliative Care and Remote Patients’ Triage – A Cross-Sectional Study

“…Despite the fact that primary care physicians, in most situations, should be the crucial providers of PC in communities, local partnerships with PC centers are strongly recommended [12]. Generalists should cooperate with the specialist outpatient PC at least within a consultation model, when consultants do not need to take over all aspects of care [37]. What is more, the whole health care system should also facilitate primary care development, with adequate resources and nancial incentives to support education as well as collaboration within the interdisciplinary teams [38].…”

A Systematic Review of the Development and Implementation of Needs-Based Palliative Care Tools in Heart Failure and Chronic Respiratory Disease

“…People living with these progressive conditions will eventually experience physical function decline, as well as changes to their psychological, social and spiritual functioning and wellbeing ( 6 – 8 ). Despite comparable mortality rates and symptom burden, fewer people with these conditions are referred to palliative care services and when they are it is typically later compared to those with a cancer diagnosis ( 9 – 11 ). For instance, a Canadian retrospective population-based study reported that significantly fewer patients with COPD received specialist palliative care (SPC) compared to those with lung cancer (20 vs. 57%) ( 12 ).…”