Access to early palliative care in a cancer center in Mexico.

Abstract

139 Background: Early palliative care (PC) improves the outcomes of patients with advanced cancer, and ASCO has issued guidelines to encourage the integration of PC into standard oncology care. However, even in developed nations, many patients fail to obtain a timely PC evaluation. We reviewed current practices in the assessment of PC needs and use of PC services in a cancer center in a developing country. Methods: All patients with newly diagnosed advanced solid tumors seen at the National Institute of Medical Science & Nutrition in Mexico City from 10/2015 to 03/2016 were included. Demographic and clinical characteristics, data regarding assessment of PC needs, and referrals to PC services were retrospectively obtained from chart reviews for the first year after diagnosis. Frequencies and summary statistics were utilized. Results: 77 patients were included (median age 62 years; range 19-88; 55% male). 53% had gastrointestinal, 21% genitourinary, and 16% other tumors. The most commonly assessed symptom by oncologists (in at least one visit) was pain in 77% of patients, followed by anorexia (75%), fatigue (70%), nausea (57%), dyspnea (28%), and depression/anxiety (13%). 30% of patients were referred to PC in the first year after diagnosis. Median time from diagnosis to PC referral was 138 days (range 25-467). The most common causes for PC referral were pain (38%), delirium (23%), dyspnea (20%) and fatigue (20%). Only 1% of patients completed advance directives. 42% died during follow-up, of which 38% had previous PC visits. Median time from first PC visit to death was 15.5 days (range 1-70). Median time from last chemotherapy to death was 72.5 days (range 2-1201). Conclusions: Less than a third of the patients were referred to PC early in the course of their disease, and many PC needs were not routinely evaluated. Novel strategies are needed to improve access to early PC in developing countries.