Systematic EPC in advanced pancreatic cancer patients significantly improved QoL with respect to on-demand EPC.

No abstract

As of today (31st August 2020) more than 25,000,000 subjects have been recognized worldwide to be infected with SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), with almost 900,000 deaths. Italy, Spain, and France in Europe have been the first affected countries, along with the United Kingdom and, outside Europe, United States of America as well as Brazil have the highest number of deaths as well as of infected subjects. 1 The impact of respiratory virus infections on morbidity and mortality in patients with cancer is widely recognized, with a risk of being hospitalized which is fourfold higher compared to age-matched subjects. 2 In this epidemiological scenario, older persons with cancer are at particularly high risk of adverse outcomes, 3,4 because of their actual risk of getting the disease, as well as for a higher likelihood of being denied proper and timely cancer treatment in order to protect them from COVID-19

Benefits of early palliative care referral in oncology are well-validated. At the Veneto Institute of Oncology-IRCCS, a simultaneous-care outpatient clinic (SCOC) has been active since 2014, where patients with advanced cancer are evaluated by an oncologist together with a palliative care team. We prospectively assessed SCOC patients’ characteristics and SCOC outcomes through internal procedure indicators. Data were retrieved from the SCOC prospectively maintained database. There were 753 eligible patients. The median age was 68 years; primary tumor sites were gastrointestinal (75.2%), genitourinary (15.0%) and other sites (9.8%). Predominant symptoms were psychological issues (69.4%), appetite loss (67.5%) and pain (65.9%). Dyspnea was reported in 53 patients (7%) in the referral form, while it was detected in 226 patients (34.2%) during SCOC visits (p < 0.0001). Median survival of patients after the SCOC visit was 7.3 months. Survival estimates by the referring oncologist were significantly different from the actual survival. Psychological intervention was deemed necessary and undertaken in 34.6% of patients, and nutritional support was undertaken in 37.9% of patients. Activation of palliative care services was prompted for 77.7% of patients. Out of 357 patients whose place of death is known, 69.2% died at home, in hospice or residential care. With regard to indicators’ assessment, the threshold was reached for 9 out of 11 parameters (81.8%) requested by the procedure. This study confirmed the importance of close collaboration between oncologists and palliative care teams in responding properly to cancer patients’ needs. The introduction of a procedure with indicators allowed punctual assessment of a team’s performance.