Timing of palliative care referral and aggressive cancer care toward the end-of-life in pancreatic cancer: a retrospective, single-center observational study View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2019-12

AUTHORS

Natasha Michael, Greta Beale, Clare O’Callaghan, Adelaide Melia, William DeSilva, Daniel Costa, David Kissane, Jeremy Shapiro, Richard Hiscock

ABSTRACT

BACKGROUND: Pancreatic cancer is noted for its late presentation at diagnosis, limited prognosis and physical and psychosocial symptom burden. This study examined associations between timing of palliative care referral (PCR) and aggressive cancer care received by pancreatic cancer patients in the last 30 days of life through a single health service. METHOD: A retrospective cohort analysis of end-of-life (EOL) care outcomes of patients with pancreatic cancer who died between 2012 and 2016. Key indicators of aggressive cancer care in the last 30 days of life used were: ≥1 emergency department (ED) presentations, acute inpatient/intensive care unit (ICU) admission, and chemotherapy use. We examined time from PCR to death and place of death. Early and late PCR were defined as > 90 and ≤ 90 days before death respectively. RESULTS: Out of the 278 eligible deaths, 187 (67.3%) were categorized as receiving a late PCR and 91 (32.7%) an early PCR. The median time between referral and death was 48 days. Compared to those receiving early PCR, those with late PCR had: 18.1% (95% CI 6.8-29.4%) more ED presentations; 12.5% (95% CI 1.7-24.8%) more acute hospital admissions; with no differences in ICU admissions. Pain and complications of cancer accounted for the majority of overall ED presentations. Of the 166 patients who received chemotherapy within 30 days of death, 23 (24.5%) had a late PCR and 12 (16.7%) an early PCR, with no association of PCR status either unadjusted or adjusted for age or gender. The majority of patients (55.8%) died at the inpatient palliative care unit. CONCLUSION: Our findings reaffirm the benefits of early PCR for pancreatic cancer patients to avoid inappropriate care toward the EOL. We suggest that in modern cancer care, there can sometimes be a need to reconsider the use of the term 'aggressive cancer care' at the EOL when the care is appropriately based on an individual patient's presenting physical and psychosocial needs. Pancreatic cancer patients warrant early PCR but the debate must thus continue as to how we best achieve and benchmark outcomes that are compatible with patient and family needs and healthcare priorities. More... »

PAGES

13

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12904-019-0399-4

DOI

http://dx.doi.org/10.1186/s12904-019-0399-4

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1111750921

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30691417


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252 https://www.grid.ac/institutes/grid.266886.4 schema:alternateName University of Notre Dame Australia
253 schema:name Departments of Psychosocial Cancer Care and Medicine, St. Vincent’s Hospital, The University of Melbourne, Melbourne, VIC, Australia
254 Institute for Ethics and Society, University of Notre Dame, Sydney, NSW, Australia
255 Palliative and Supportive Care Research Department, Cabrini Institute, 154 Wattletree Road, 3144, Malvern, VIC, Australia
256 School of Medicine, University of Notre Dame, Sydney, NSW, Australia
257 rdf:type schema:Organization
258 https://www.grid.ac/institutes/grid.415379.d schema:alternateName Mercy Hospital for Women
259 schema:name Mercy Hospital for Women, Melbourne, VIC, Australia
260 rdf:type schema:Organization
261 https://www.grid.ac/institutes/grid.440111.1 schema:alternateName Cabrini Hospital
262 schema:name Palliative and Supportive Care Research Department, Cabrini Institute, 154 Wattletree Road, 3144, Malvern, VIC, Australia
263 rdf:type schema:Organization
 




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