Early palliative care involvement in gastrointestinal malignancies: A community cancer center perspective.

Abstract

198 Background: Early involvement of palliative care (PC) specialists enhances quality of life for patients with advanced gastrointestinal (GI) cancer. Methods: This retrospective study evaluated patients with newly diagnosed stage III and IV GI cancer seen at a large community cancer center between 10/1/22 and 9/30/23. We compared patients seen by a PC provider in clinic at least once to those without an outpatient PC visit within the one-year study period. Results: 283 patients with stage III/IV colorectal (42%), gastroesophageal (23%), pancreatic (16%), hepatobiliary (12%), and other GI cancers (8%) received care within the study period (Table). Of these, 49 (17%) had at least one PC clinic visit, and 234 (83%) had no PC visits. Patients with pancreatic (35% vs 12%) and hepatobiliary cancer (20% vs 10%) were over-represented in the group receiving PC vs those without PC, while patients with colorectal cancer were under-represented (20% vs 47%). Greater percentages of patients in the group receiving PC completed advanced care planning (ACP) documents (63% vs 24%) and died during the study period (65% vs 15%). Conclusions: A minority of patients with GI malignancies at a large community cancer center are seen by an outpatient PC provider during the first year after diagnosis. These patients are more likely to have tumor types associated with worse prognosis, to complete ACPs, and to die within one year. Broader delivery of early PC will require expanded services in community cancer centers and continued development of tools for identifying patients most likely to benefit. The distribution of gastrointestinal cancer between outpatient palliative care visit and no outpatient palliative care visit. Primary cancer PC No PC Total Colorectal 10 (20% | 8%) 110 (47% | 92%) 120 (42% | 100%) Gastroesophageal 10 (20% | 16%) 54 (23% | 84%) 64 (23% | 100%) Pancreatic 17 (35% | 39%) 27 (12% | 61%) 44 (16% | 100%) Hepatobiliary 10 (20% | 30%) 23 (10% | 70%) 33 (12% | 100%) Other GI 2 (4% | 9%) 20 (9% | 91%) 22 (8% | 100%) Total 49 (100% | 17%) 234 (100% | 83%) 283 (100% | 100%) PC: Palliative care.