1611P - Specialist palliative care (SPC) in haematological malignancy: Establishing practices in a UK tertiary cancer centre (TCC)

Abstract

BackgroundInternational consensus supports early integration of SPC in oncological disease. Haematological malignancies differ in nature from solid site tumours. Remitting and relapsing trajectories, late salvage treatments, and divergent outcomes make for difficult prognostication and traditional markers of ‘good’ end of life care may not translate well to this group. However, disease is often incurable and physical and psychological symptom burden high, making SPC input essential. The authors propose an integrated care model to achieve this, utilising predefined triggers to identify unmet need and to guide SPC involvement from time of diagnosis. Such a service, “Triggers”, has been successfully developed for other cancer groups at the TCC. Through improved understanding of current practices we plan to tailor this service to meet the unique needs of the haematology patient group. MethodsA retrospective audit of electronic records was completed for patients dying of haematology malignancy in the 12 months to 31/3/18. Data relating to SPC referral, DNAR documentation, active interventions, place of death and diagnosis sub-type was collected. ResultsOf 108 patients identified, 67 died in hospitals, including 43 at the TCC. Of 26 deaths within 30 days of discharge from the TCC, 100% of those with a previous SPC referral (16) died in the community while 80% of those without (10) died in a local hospital.Table1611PTableTotals / RangeMedianDeaths in year ending 31/3/19108Documented referrals to SPC72/108Time from Diagnosis to death0 – 23 years3 yearsTime from SPC referral to death0 – 10 years6 daysFor Tertiary Centre in-patient deaths only:Number of TCC in-patient deaths43Chemotherapy in last 30 days25/43Blood transfusion in last 30 days38/432 days pre deathPlatelets in last 30 days34/433 days pre deathTPN in last 30 days11/434 days pre deathTime from DNAR record to death0 – 30 days3 days pre death ConclusionsHaematological intervention remains frequent up until death but SPC involvement is relatively delayed. Later SPC input is expected to limit effective relationship building and advance care planning and the data shows differences in place of death for those with and without SPC referral. Results suggest an opportunity to support patient-centred care through the development of an integrated service with early SPC accessibility and a consultative survey is underway to ascertain how this might best be achieved. Legal entity responsible for the studyThe authors. FundingHas not received any funding. DisclosureAll authors have declared no conflicts of interest.