Palliative care in gynecologic oncology: a narrative review of current literature and vision for the future

Abstract

Background and Objective: Several professional societies have recommended incorporating palliative care into routine oncology care, yet palliative care remains underutilized among women with gynecologic cancers. This narrative review highlights current evidence regarding utilization of palliative care in gynecologic oncology care. Additionally, the authors offer recommendations to increase early integration and utilization of palliative care services, improve education for current and future gynecologic oncology providers, and expand the palliative care workforce. Methods:The authors reviewed studies of palliative care interventions in oncology settings, with an emphasis on studies that included women with gynecologic malignancies. A panel of author/experts were gathered for a semi-structured interview to discuss the future of palliative care in gynecologic cancer care.The interview was recorded and reviewed to highlight themes.

When insight yields inaction: the role of implementation science in improving palliative care integration

“…A prior systematic review in 2016 revealed at least twenty published criteria assessing six functional domains (25). This includes multiple sets of "consensus criteria" introduced by NCCN, Center to Advance Palliative Care (CAPC), and an International Delphi consensus with further studies performed with adapted or modified versions of the consensus criteria (13,25). Similarly, multiple patient symptom screening instruments exist through ESAS-r and the Patient Reported Outcomes Measurement Information System (PROMIS ® ) (22,23).…”

“…Identified screening methods underperformed in terms of increasing palliative care utilization across the spectrum of practice settings. Salyer et al (2022) proposed that palliative care will be implemented through one of three models based on whether a given institution has access to (I) primary palliative care only, (II) primary palliative care + inpatient specialty palliative care only, or (III) primary palliative care + inpatient and outpatient specialty palliative care (13). Hui et al (2022) similarly suggested that given the scarcity of palliative care resources, screening should move beyond solving for early palliative care referral (i.e., how can we identify the entire universe patients who may benefit from integrated palliative care and get them evaluated by palliative care as expediently as possible?)…”

“…Fee-for-service reimbursement for palliative care can also create undue burden for patients with co-pay out-of-pocket expenses and for palliative care practices by reimbursing only 20-60% of operating expenses (17). Facilitators of palliative care consultation can include positive experiences with palliative care among a patient's social network, buy-in on role of palliative care from primary oncologist, integration of palliative care into multidisciplinary tumor boards and patient care conferences, and increased palliative care education among medical and surgical oncologists (13). Innovative membership-based reimbursement structures can also increase access and affordability of palliative care (17).…”

“…Screening gynecologic oncology patients by one or more of the methods presented by Vetter is only one piece of the process of implementing integrated palliative care. Two recent reviews by Salyer et al (2022) and Hui et al (2022) highlight the importance of designing interventions to increase palliative care uptake that are compatible with the operational model for palliative care delivery in a given healthcare system (13,14). Vetter's reported results describing existing palliative care screening tools in gynecologic oncology demonstrate the need to include implementation science metrics and methodology in future studies in this area.…”

Palliative care is a critical part of gynecologic oncologic care

“…They suggest guidelines for when to refer to palliative care, tailored to settings with varied access to palliative care consultations as inpatient, outpatient or both. They also introduce "primary palliative care", which are aspects of palliative care that they argue gynecologic oncologists should be expected to provide; for example, basic management of nausea, constipation, and goals of care conversations (3). They also focus on ways that this training can be achieved.…”