Trends in palliative medicine and aggressive care at the end of life for women with gynecologic malignancies: a 15-year single institutional experience

Abstract

Objectives: For over a decade palliative medicine in conjunction with disease modifying therapy has been recommended for women with metastatic, recurrent and symptomatic malignancies. The objective of this study was to compare the prevalence of palliative care consultations as well as aggressive care at the end of life (ACE) scores between women who died from gynecologic malignancies from 2005-2010 verse 2015-2020 as stratified by timely verses no/untimely consultation. We hypothesize that in the past fifteen years there has been an increase in palliative medicine consultation. Methods: After IRB approval data including patient demographics, histopathology, treatment and metrics of quality palliative care were abstracted from patients who died from gynecologic malignancies between 2005-2010 and 2015-2020 at a tertiary care medical center. Timely palliative consultation was defined as ≥to 30 days before death. Metrics contributing one point each to the ACE scores were 1) admission to ICU within 30 days of death, 2) hospital admission more than 14 days in the last 30 days of life, 3) more than one hospital admission during the past 30 days of life,4) more than one emergency room visit during the last 30 days of life,5) death in an acute care setting, 6) initiation of a new chemotherapy during the last 30 days of life, 7)last chemotherapy within 14 days of death, and 8) hospice admission less than 3 days before death. Data were reported in a descriptive fashion and analyzed using Student's T test, Wilcoxon Scores, and chi-square analysis with Stata 14.2. Results: Of 147 women in 2015-2020 cohort, 59(40%) had timely referral to palliative medicine compared to 18(18%) of the 2005-2010 cohort (p Download : Download high-res image (142KB) Download : Download full-size image Conclusions: There has been an increased consultation frequency and proportion of timely referrals to palliative medicine comparing contemporary to historical deaths from gynecologic malignancies. In both time periods overall ACE scores and some component scores were improved for women who received timely referral to palliative medicine. These data should be interpreted with caution secondary to baseline differences in cohorts who received timely palliative consultation verses untimely/no consultation