Resource utilization and futile management in terminally ill cancer patients: A perspective from hospital-based palliative care program in Saudi Arabia.

Abstract

e24006 Background: The palliative care needs for cancer patients are on the rise across MENA region (Middle East and North Africa) with economical and quality of health-care implications. We believe this is the first reported study in the Saudi Arabia about resource utilization and futile management from a hospital-based palliative care program for terminally ill cancer patients. Methods: The data was collected retrospectively, the data collection took palace in the year 2018. The data collection tool consisted of seven parts, 1- Patient’s information, 2- Initial diagnostic procedures, 3- Imaging procedures 4- Pathology and laboratories workup, 5- Treatment modalities (if any), 6-Healthcare facility and resources utilization, 7- Palliative care utilization. Results: A total of 103 patients were included, their median age 66 years (20-94), and (58%) were females, the majority of the cases had stage IV cancer 99 (96.1%), half of them with gastrointestinal cancer 44 (42.7%). During their stay under PCU, 59 (57.3%) had chest X-rays, 21.4% ECG and 14.6% Abdominal ultrasound, various types of Computed Topographies (CT) were done for 18 patients (17.4%). Daily multiple times glucose checking was done for all patients, and complete blood count was done for 81.6%. Only 31 patients (30%) visited the Emergency Department ED after being transferred to PCU, 83 patients (80.6%) had no outpatient clinic visit at all. The median duration for palliative care was 17 days, while the median duration for oncology service is 193 days. The majority of the patients (n = 68) died within 30 days from transfer to palliative care, among them 4 patients (4 %) died on the same day of transfer. No statistically significant differences were found between males and females regarding the days from diagnosis to palliative transfer, days from diagnosis to palliative referral, the number of visits to ED, and the number of non- ICU admissions. Conclusions: Many patients were exposed to unnecessary procedures with no clinical implications, e.g. CT scans, EKGs, daily multiple labs. There is a significant delay in transferring the patients to palliative care service, policies and regulations are needed for timely transfer to palliative care services for cancer patients. Early complex advance care planning is an essential tool to combat futile management. 100% deaths in palliative care unit may reflect limitations for palliative care providers for alternate placements. Predominant use of palliative care unit for the end of life care would drive health care cost to higher level from direct and indirect expenses.