Impact of palliative care on end-of-life management of cancer patients dying in the hospital.

Abstract

e20613 Background: A substantial number of cancer patients receive inpatient care at the end-of-life (EoL). Involvement of palliative care teams during the course of cancer treatment has been shown to improve quality of life (QoL) in cancer patients. In this study, we compare the EoL care of cancer patients dying in the hospital under medical oncology (MO) and palliative care (PC) services. Methods: A retrospective review of medical records of adult cancer patients who received chemotherapy during their illness and died in our hospital between January 2010 and January 2012 was conducted. The quality metrics measured as endpoints were: chemotherapy given within 21 days of death, death in the ICU, CPR at time of death, and time from last chemotherapy to death (TLCD). These endpoints were compared between patients who died under the MO service (cohort A) and those dying under PC service (cohort B). Chi-square test and T-test were used to compare the endpoints between the two cohorts. Results: Of the 106 cancer patients who died in the hospital, 40 and 66 were in cohorts A and B respectively. 30% of all patients were 65 years of age or older, and were equally distributed between the two cohorts. Patients in cohort A were more likely to receive chemotherapy within last 3 weeks of life (27.5% versus 7.5%, p=0.012, 95% CI 4.16-37.15), to have CPR at time of death (15% versus 0%, p=0.005, 95% CI 4.2-29.8) and to die in the ICU (52.5% versus 1.5%, p=<0.001, 95% CI 33.3-67.1) as compared to patients in cohort B. The average time from last chemotherapy to death was significantly longer (221 days) for cohort B patients as compared to cohort A patients (96 days), p=0.01. Patients in cohort A who had PC consultation during their hospitalization had no differences in the measured endpoints when compared to patients in cohort B. Conclusions: Cancer patients who die in the hospital while under MO service without PC involvement tend to have more aggressive EoL care. This may impact negatively on some QoL features. Early referral to palliative care services may facilitate better understanding and fulfillment of the needs of cancer patients and their caregivers by the healthcare-providers.