1432P - The Impact of Palliative Care on the Aggressiveness of End-of-Life Cancer Care in Patients with Advanced Pancreatic Cancer

Abstract

ABSTRACT Background To improve end-of-life care, quality indicators have been developed to avoid overly aggressive care in patients with advanced cancer. Advanced pancreatic cancer is a highly lethal disease with few life-prolonging options. Specialized palliative care (PC) consultation (defined as a physician consultation focusing on PC needs, lasting at least 40 minutes) could reduce overly aggressive care in this population. Purpose To examine the impact of PC consultation on (i) subsequent use of chemotherapy within 14 days of death; (ii) more than one emergency department (ED) visit; (iii) more than one hospitalization; and (iv) at least one intensive care unit (ICU) admission, all within 30 days of death. Methods A retrospective population-based cohort study using linked administrative databases was conducted with patients diagnosed with advanced pancreatic cancer from Jan 1 2005 to Dec 31 2010. Analysis was limited to those who had received palliative chemotherapy. Multivariable logistic analyses were performed with the above quality indicators as the outcomes of interest and PC as the main covariate, adjusting for other variables (age, sex, rurality, and health region). Results Of the 6076 patients who had advanced pancreatic cancer, 5381 of these patients had died at last follow-up, and 1644 of those had received palliative chemotherapy. In this cohort, 986 (60%) received a palliative care consultation, 218 (13%) received chemotherapy near death, 53 (3%) patients went to the ICU near death, 218 (13%) had multiple ED visits near death, and 213 (13%) had multiple hospitalizations near death. In multivariable analysis, PC consultation was associated with decreased use of chemotherapy near death (odds ratio (OR) 0.23; 95% confidence interval (CI) 0.17-0.32), and lower risk of ICU admission near death (OR 0.19; 95% CI 0.10-0.36), multiple ED visits near death (OR 0.41; 95% CI 0.30-0.55), and multiple hospitalizations near death (OR 0.37; 95% CI 0.27-0.50). Conclusions In patients with advanced pancreatic cancer who are receiving palliative chemotherapy, PC involvement is associated with less frequent overly aggressive care. Future analysis will explore the effect of timing of PC consultation (early vs late) on outcomes, and expand the cohort to all patients with advanced disease. Disclosure All authors have declared no conflicts of interest.