From evidence to practice: early integration of palliative care in a comprehensive cancer center

Abstract

The American Society of Clinical Oncology (ASCO) recommends that all patients with a diagnosis of advanced cancer be referred to a palliative care team within 8 weeks of diagnosis. The bene ts of early integrated palliative care are well recognized, however, there is a lack of consensus to guide operational aspects of a palliative care service within a comprehensive cancer center. In this study, we explore current palliative care referral patterns at an academic cancer center and provide recommendations for operationalizing palliative care services as a program within comprehensive cancer centers in order to adequately meet the needs of patients with advanced cancer. MethodsA retrospective chart review of patients with newly diagnosed metastatic cancer or advanced hematologic malignancy seen by the palliative care team at a comprehensive cancer center from January 1, 2021, to October 31, 2021 was conducted. IRB approval was obtained prior to the initiation of the chart review. ResultsA total of 243 patients with newly diagnosed metastatic cancer, or advanced hematologic malignancy were included in this review. Patients with gastrointestinal (26%), gynecologic (19%), and thoracic (21%) malignancies constituted 66% of the total cohort. The most frequent reason for referral was pain (52%). Thirty-nine percent of patients were referred within 8 weeks of an advanced cancer diagnosis. ConclusionASCO recommends that all patients with advanced cancer be referred to a palliative care specialist within 8 weeks of diagnosis. Of the newly referred patients with advanced cancer, only 39% were referred to the palliative care

Evolution of Complexity of Palliative Care Needs and Patient Profiles according to the PALCOM Scale: Pooled Analysis of the Cohorts for the Development and Validation of the PALCOM Scale in Advanced Cancer Patients

“…[1,2] Multiple controlled clinical trials have demonstrated that early palliative care (EPC) significantly improves the control of symptoms, emotional distress, the perceived quality of life and the satisfaction of patients with advanced cancer. [3][4][5][6][7][8][9][10][11][12][13][14][15] Some of these clinical trials have also confirmed that EPC can increase patient survival, reduce the futile use of chemotherapy and optimize the use of healthcare resources. [1,15,16] Taking into account the position of the WHO and the robust scientific evidence available, most of the scientific societies and consensus documents of experts in cancer recommend care by specialised multidisciplinary EPC teams for all patients with advanced cancer in parallel with etiological treatment (American Society of Clinical Oncology [ASCO], European Society of Medical Oncology [ESMO], National Comprehensive Cancer Network [NCCN], Lancet Commission).…”

Evolution of Complexity of Palliative Care Needs and Patient Profiles According to the PALCOM Scale (Part Two): Pooled Analysis of the Cohorts for the Development and Validation of the PALCOM Scale in Advanced Cancer Patients

“…Multiple controlled clinical trials have demonstrated that early palliative care (EPC) significantly improves the control of symptoms, emotional distress, the perceived quality of life and the satisfaction of patients with advanced cancer [3][4][5][6][7][8][9][10][11][12][13][14][15]. Some of these clinical trials have also confirmed that EPC can increase patient survival, reduce the futile use of chemotherapy and optimize the use of healthcare resources [1,15,16].…”

Patient and Provider Attitudes and Preferences Regarding Early Palliative Care Delivery for Patients with Advanced Gastrointestinal Cancers: A Prospective Survey

“…Accordingly, SPC is reserved for patients with the most complex symptom burden. However, multiple barriers to realizing the integration of a palliative approach to care in oncology have been identified, including a lack of role clarity between providers, professional reluctance to begin these discussions early in the disease trajectory, and differences in understanding of EIPC between patients and their providers [ 13 , 14 , 15 , 16 ].…”