“She would be flailing around distressed”: Addressing the hidden crisis in the home of patients being treated for cancer.

Abstract

147 Background: Metastatic cancer patients who have progressed on multiple lines of chemotherapy and/or have poor functional status are at risk for significant symptoms, ineffective treatments, and hospice under-utilization. Appreciating the full extent these patients’ struggles is challenging during brief oncology clinic visits. We describe Community Bridges (CB), a home-based palliative care program. Methods: The CB pilot featured a 3-person home-based palliative care MD, NP, and RN team. Patients with metastatic cancer and complex care needs ( > 3 chemotherapy lines, ECOG ≥ 3, history of missed PC clinic appointments, and/or clinical trial participation) were offered 2 months of serial home visits and phone support. Symptom severity, satisfaction, and caregiver burden were assessed. Results: 18 patients enrolled. Mean age was 66. At baseline, 79% of patients reported mild-moderate pain, 43% severe fatigue, 38% moderate-severe depression, and 65% poor-fair QOL. Half of patients died within the 2-month program or within 3 months later. 35% of patients enrolled in hospice while in CB, with a LOS of 10 days. Caregiver burden was high. 60% of patients (n = 6) and 100% of caregivers (n = 7) agreed CB provided services not otherwise available. All would recommend the program to others. Participants reported CB helped them navigate the medical system and reduce stress. Caregivers reported CB helped their loved ones regain control of care. The CB team noted key program strengths were accurately identifying the patients’ home needs, communicating findings to oncologists, and intervening quickly when patients were at the end of life and/or actively dying. Conclusions: CB met patients in their final stages, when they were experiencing heavy symptom burden, functional decline, patient/caregiver distress, and risk of death. The CB team was able to assess and respond to changing needs during key transitions points, and report the realities at home to help inform oncologists’ treatments. Although CB was not designed as a “crisis service,” it often served in that role. Home-based palliative care programs like CB may bridge the gap for patients desiring ongoing cancer treatment but in need end-of-life services.