Evaluation of a multi-disciplinary, systematic approach to palliative care for patients undergoing active treatment for head and neck cancer.

Abstract

91 Background: Patients who receive concurrent chemoradiation therapy for head and neck cancer (H&N CA) commonly experience a range of symptoms, including dysphagia, weight loss, and dehydration, which may impact their treatment and prognosis. Treatment of patients with H&N CA often involves multiple specialties, including Surgery, Medical, and Radiation Oncology, and Palliative Care. In January 2017, Kaiser Permanente Colorado (KPCO) began providing early, integrated palliative care for all H&N CA patients (stages I-IV) starting chemoradiation at a single clinic site. This quality improvement program was subsequently evaluated for ease of implementation and, secondarily, to discern impacts on patient care. Methods: Retrospective chart review was performed for patients undergoing treatment in 2017 for H&N CA with concurrent chemoradiation therapy who also received integrated palliative care (n = 16) compared to standard care patients (n = 32) from 2015-2017. Data on rates of unplanned hospitalizations and feeding tube placement, completion of Medical Durable Power of Attorney (MDPOA) and Edmonton Symptom Assessment Scale (ESAS) were extracted from the electronic health record. Descriptive and inferential statistics were used to review data. Assessment of implementation occurred by interviews with the clinical teams. Results: Implementation of the program required intentional work between departments to define roles and reduce unwanted overlap. Standardized nursing assessments of symptom burden were developed. Patients followed in an integrated fashion had increased MDPOA and ESAS completion (38% vs 6%) and decreased hospital admissions (19% vs 53%) and unplanned PEG tube insertions (13% vs 34%). Differences were statistically significant for hospitalizations (p = 0.022) and ESAS completion (p = 0.006). Conclusions: Development of integrated patient management required intentional inter-department team communication and did not disrupt the clinic environment of any department. Lower hospitalization rates may be related to increased monitoring of symptoms. Based on this experience, the program was expanded to other clinical sites within KPCO.