Indicators of integration at ESMO Designated Centres of Integrated Oncology and Palliative Care

Abstract

BackgroundA recent international consensus panel identified 13 major indicators to assess the level of integration between oncology and palliative care. We examined these indicators among European Society for Medical Oncology (ESMO) Designated Centres (ESMO-DCs) of Integrated Oncology and Palliative Care (PC) and determined the centre characteristics associated with greater integration.MethodsThis is a preplanned secondary analysis of a recent survey to characterise the structure, processes and outcomes of the palliative care programmes at ESMO-DCs. We assessed the level of integration using 13 major indicators. We calculated two Palliative Care and Oncology Integration Indexes consisting of all 13 indicators (PCOI-13, range 0–13) and 9 of the 13 indicators (PCOI-9, range 0–9), with a higher index indicating greater integration.ResultsThe survey response rate was 152/184 (83%). Among the 13 major indicators, interdisciplinary team was most likely to be achieved (95%), while early referral to palliative care (median time from referral to death >6 months before death) was only present in 24 (20%) of ESMO-DCs. The median PCOI-13 was 7.8 (IQR 6.4–9.6) and the median PCOI-9 was 6 (IQR 5–7). The presence of dually trained palliative oncologists was associated with higher PCOI-13 (median 8.4 vs 7.0; p=0.01) and PCOI-9 (median 6 vs 5; p=0.03). Non-tertiary hospitals generally had higher PCOI-13 (median 8.6 vs 7.2; p=0.01) and ESMO-DCs outside of Europe had higher PCOI-9 (median 7 vs 6; p=0.03).ConclusionsAssessment of the level of integration at ESMO-DCs with PCOIs highlighted strengths, areas for further development and how double-boarded palliative oncologists may promote integration.

State of palliative care services at US cancer centers: An updated national survey

“…This growth is encouraging because outpatient clinics represent the only branch of palliative care to facilitate timely referrals in the ambulatory setting, and earlier referral to palliative care is associated with improved patient and caregiver outcomes . NCI‐designated cancer centers reported that 95% of them were equipped with outpatient palliative care clinics, and this is higher than previous national and international surveys . However, this was true for less than half of non–NCI‐designated cancer centers, which serve a large proportion of patients with cancer in the United States.…”

“…This study included 2 separate surveys for each cancer center: one directed to the cancer center executive and the other directed to the palliative care program leader where applicable. These survey questions had been used in several national and international studies, and the methodology for survey creation had been reported previously . Briefly, 4 medical oncologists and 3 palliative care specialists generated the questions on the structures, processes, and outcomes of specialist palliative care programs after conducting a comprehensive review of the medical literature and national palliative care guidelines, with further pilot testing for readability and face validity.…”

“…To facilitate direct comparisons against the 2009 findings, the same survey questions and answer options were used in 2018 . The 2018 palliative care program leader survey also included 8 new questions that assessed the level of integration of oncologic and palliative care within a given cancer center according to indicators developed by an international panel . This study protocol was reviewed by the institutional review board at The University of Texas MD Anderson Cancer Center and was granted exemption status.…”

Impact, challenges and limits of inpatient palliative care consultations – perspectives of requesting and conducting physicians

“…Early integration of palliative care (PC) has become increasingly accepted especially in cancer patients [1]. Even though the optimal time point and extent of PC is still in debate [2], there is little doubt of a general benefit [3]. It has shown to improve patients' quality of life and symptom control [4], to reduce psychological distress for patients and family caregivers [5,6], and to decrease health care costs due to for example less intensive care unit treatment [7].…”

How I treat cancer special issue

“…Within the 3 years of its existence, ESMO Open – Cancer Horizons has so far published a total of 330 articles dealing with all possible aspects of cancer and cancer care. These have included papers in the following areas: epidemiological studies1 2; access to cancer care3–7; the advent of biologicals and their broad use in the clinic8 9; various aspects of magnitude of clinical benefit achieved by the use of certain drugs10 11; biological considerations on the regulation of tumour growth12 13 and propagation14–16; clinical cutting-edge papers on the treatment of cancer in selected unfamiliar situations1 17–21; new treatment options either registered by the European Medicines Agency (which ESMO Open regularly publishes in its ‘EMA Corner’22) or a broader understanding of existing compounds23–28 in an abundance of various cancers29–35 and quality of life issues of cancer patients 3 36–42. These patient-oriented publications were complemented by aspects concerning the oncological profession 4 43.…”