Patterns of palliative care referral in platinum resistant ovarian cancer demonstrate reactive rather than proactive approach

Abstract

ObjectiveTo evaluate patterns of palliative care (PC) integration in patients with platinum resistant ovarian cancer. MethodsSingle institution retrospective study of patients with ovarian, tubal, or peritoneal high-grade carcinoma treated 2011–2020. Platinum resistance was identified by chemotherapy regimen or provider definition. Data was extracted evaluating treatment regimens, time to progression, PC and hospice referrals, and survival. Descriptive statistics and survival analyses were performed. ResultsWe identified 258 patients with platinum resistant ovarian cancer. Median survival from diagnosis of platinum resistance was 15 months (range 0–161). Most (71 %) patients were referred to PC, with 43 % of referrals within 3 months of death. Fourteen percent of patients were referred directly to hospice without PC involvement. Of 46 patients living with platinum resistant disease, 93 % meet criteria for early PC referral, but less than half have seen PC. Median time from platinum resistance to PC referral was 9 months (range 0–157) and from PC referral to death was 3 months (range 0–110). Median time from platinum resistance to hospice referral was 7 months (range 1–57) and from hospice referral to death was < 1 month (range 0–12). ConclusionWhile rates of PC referral in our cohort are high compared with other single institution cohorts, timing of PC referral suggests referral patterns that are reactive to clinical decline rather than proactive as per national recommendations. A significant percentage of patients are directly referred to hospice for end-of-life care, reflecting missed opportunity for concurrent PC and oncology care earlier in the disease course. Diagnosis of platinum resistance should serve as a stimulus for PC involvement.