A Retrospective Analysis of Factors Affecting Palliative Care Consults in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy.

Robin R Rodriguez,Gene Finley,Laila Babar,Amber Blackledge,Dulabh Monga,Lisa Doverspike,Obaid Ashraf,Ashish Sethi,Herman Lo,Moses S Raj

doi:10.7759/cureus.12589

Abstract

PurposeThis study was conducted to determine factors that influence palliative care (PC) consultation in patients receiving cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC).Patient and methodsWe queried our Electronic Medical Record EPIC for a list of patients who underwent cytoreductive surgery with HIPEC or hyperthermic intrathoracic chemotherapy (HITEC) in the hospital from April 2016-April 2019. Data was manually extracted and patients who did not meet our criteria were excluded. Patients were divided on the basis of palliative care consults and differences between the groups were analyzed. Odds ratios (OR) with p-value of 0.05 and confidence interval of (CI) 95% were calculated.ResultsWe identified 55 patients of whom 34 met our inclusion criteria: 11 males and 23 females with an average age of 56 years at the time of diagnosis. Eight patients (23%) had PC, with six having commercial insurance, seven married, and six with more than one comorbid medical issue. Comorbidities >1 (OR: 0.12; CI: 0.02-0.76; p: 0.02) and age >40 (OR: 0.015; CI: 0.0007-0.3029; P: 0.006) were associated with a higher likelihood of PC. Gender, insurance type, and marital status did not have a significant association with PC. Mean age between PC consulted patients versus non-PC consulted patients was 58.5 vs. 55.9 and median age between the two groups was 60.5 vs. 60 which also showed a trend towards higher rates of PC in the older population.ConclusionApproximately one quarter of patients who underwent CRS with HIPEC had a concurrent PC consult. Though this is better than the national average of 11-16%, it continues to be a very small number. Efforts must be made to engage PC early in the course of treatment and recognize it as an integral part of cancer care. PC is not only an end-of-life service, in fact, studies have shown that early consultations lead to higher patient satisfaction, improved quality of life, and better communication.

Highlights

The National Cancer Institute defines palliative care (PC) as care given to improve the quality of life (QOL) for patients with life-threatening diseases [1]
We identified 55 patients of whom 34 met our inclusion criteria: 11 males and 23 females with an average age of 56 years at the time of diagnosis
In a 2010 study reported in the New England Journal of Medicine, a cohort of patients with metastatic nonsmall cell lung carcinoma showed increased benefit in quality of life and decreased risk of depression when introduced early to the concept of palliative care [10]

Summary

Introduction

The National Cancer Institute defines palliative care (PC) as care given to improve the quality of life (QOL) for patients with life-threatening diseases [1]. As life-threatening illnesses inclusive of cancer affect the body of the patient and the mindset and family dynamics, palliative care seeks to offer both a physical and emotional response that is unique to the needs of each patient. According to research by Hawley, “nearly one-third of US hospitals with more than 50 beds do not have any palliative care service”. As more studies are being conducted, its role in the improvement of QOL for patients is being widely recognized.

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