Timing of specialized palliative care integration and its impact on quality of end-of-life care indicators among Latin American cancer patients.

Abstract

e24168 Background: Prior studies have shown that specialized palliative care (SPC), when integrated early during the disease trajectory, improves the quality of end-of-life care among advanced cancer patients. However, those studies were conducted in large academic cancer centers in developed countries, where the availability of human and structural SPC resources is extensive. Little is known about how the timing of SPC may affect end-of-life quality care indicators in other settings of the globe. We aimed to examine the timing of SPC over a 4-year period and how it was associated with ASCO end-of-life quality care indicators. Methods: Retrospective cohort study of all adult cancer patients referred to the SPC team and who died at Hospital Israelita Albert Einstein, Sao Paulo, Brazil, between April 2017 and April 2021.Data onpatient demographics, clinical characteristics, timing of SPC integration as measured as the median interval between first SPC consult to death (SPC1-D), and ASCO end-of-life quality care indicators were retrieved. Results: Among 292 deceased cancer patients (52% female; median age = 67; 70% ECOG ≥3), the median SPC1-D interval was 24 days. There was a decrease in SPC1-D interval in the pandemic years (April 2017 through March 2018 = 27 days; April 2018 through March 2019 = 39 days; April 2019 through March 2020 = 23 days; April 2020 through April 2021 = 15 days; p = .02). 164 (56%) had an SPC1 < 30 days before death. Patients who had an SPC1 > 30 days before death were less likely to receive chemo and targeted therapy within the last 30 days of life (Table 1). Conclusions: Integration of SPC occurred late, especially during the pandemic years. Nevertheless, earlier SPC1 improved treatment aggressiveness in end-of-life. Further efforts are needed to enhance early SPC referrals in resource-limited settings.[Table: see text]