Early Integration Of Palliative Care Research Articles

Disparities in the receipt of palliative care (PC) in metastatic renal cell carcinoma (mRCC).

e18108 Background: Early integration of PC has shown to improve quality of life and survival in some solid malignancies. In this study we sought to analyze the PC utilization in mRCC patients. Methods: Patients with mRCC reported to NCDB between 2004 & 2015 were extracted and we included the patients who died of mRCC. We classified the patients into three cohorts based on their length of survival ( < 6, 6-24, and > 24 months) to account for disease severity. Using SPSS, we performed multivariable logistic regression to determine the patient and institutional factors determining the PC use. Results: A total of 29,296 patients were analyzed. Overall, 20% (n = 5737) of the patients received PC. Among these, 7%,17%,7%, 53%, and 12% received pain management PC; palliative chemotherapy, surgery, radiation and combination therapies, respectively. On cox multivariate analysis, among patients that survived < 6 months, receipt of PC was associated with better overall survival (OS) [HR: 0.91 (CI:0.87-0.95), p < 0.01]. Patients who received PC were more likely to be of White race, non-Hispanic origin, treated at non-academic facilities, and had higher educational background (p < 0.01) (Table). Patients living in East, Central, and Mountain regions had higher odds of receiving PC than those in the Pacific coast. The odds of receiving PC were significantly higher in patients who survived for < 6 months as compared to that of > 24 months (23 vs 13%, p < 0.01). Conclusions: We noticed a significantly better OS in mRCC patients who received PC. Despite the benefits in OS and guidelines advocating the PC use, the overall PC utilization in mRCC is markedly low and plagued by race, facility type and geographic region. [Table: see text]

Palliative care and end-stage liver disease: a critical review of current knowledge.

End-stage liver disease (ESLD) is associated with high symptom burden, poor quality of life, and significant healthcare costs. Palliative care, which is not synonymous with hospice or end-of-life care, is a multidisciplinary model of care that focuses on patient-centered goals with the intent of improving quality of life and reducing suffering. This review will summarize current literature supporting the benefits of early integration of palliative care in patients in this population. Advance care planning (ACP) and goals of care discussions have been associated with improved quality of life, decreased anxiety, and improved satisfaction with care for both the patient and the caregiver. These discussions are beneficial to all patients with ESLD, including those listed for liver transplantation. Despite the resounding benefits of palliative care for patients with other advanced diseases, palliative care remains underutilized in liver disease. There is an urgent need for education of hepatology/transplant providers as well as development of society guidelines to help dissemination and acceptability of palliative care for patients with ESLD.

Timing of Palliative Care in Colorectal Cancer Patients: Does It Matter?

BackgroundPalliative care can improve end-of-life care and reduce health care expenditures, but the optimal timing for initiation remains unclear. We sought to characterize the association between timing of palliative care, in-hospital deaths, and health care costs. MethodsThis is a retrospective cohort study including all patients who were diagnosed and died of colorectal cancer between 2004 and 2012 in Manitoba, Canada. The primary exposure was timing of palliative care, defined as no involvement, late involvement (less than 14 d before death), early involvement (14 to 60 d before death), and very early involvement (>60 d before death). The primary outcome was in-hospital deaths and end-of-life health care costs. ResultsA total of 1607 patients were included; 315 (20%) received palliative care and 162 (10%) died in hospital. Compared to those who did not receive palliative care, patients with early and very early involvement experienced significantly decreased odds of dying in hospital (OR 0.21 95% CI 0.06-0.69 P = 0.01 and OR 0.11 95% CI 0.01-0.78 P = 0.03, respectively) and significantly lower health care costs. There were no significant differences in in-hospital deaths and health care costs between patients without palliative care and those who received late palliative care. ConclusionsEarly palliative care involvement is associated with decreased odds of dying in hospital and lower health care utilization and costs in patients with colorectal cancer. These findings provide real-world evidence supporting early integration of palliative care, although the optimal timing (early versus very early) remains a matter of debate.

Palliative Care Usage in Young Adult Oncology Population.

Context: Early integration of palliative care (PC) into adult oncology practice has been shown to improve quality of life and health care utilization; however, little is known about PC in young adults with cancer. Objectives: Our primary objective was to determine rates and timing of PC consultation in young adult patients with advanced solid tumor cancer at a single institution. Methods: We conducted a retrospective analysis of young adults of age 18-39 years with advanced solid tumor malignancy at an urban academic medical center between June 1, 2014 and June 30, 2015. Results: Of 129 patients identified, 70 of 129 (54%) had a PC consult and 34 of 70 were inpatient-only consults. PC consults occurred for a median of 104 days before death, and for those with inpatient-only consults, PC consults occurred for a median of 18 days. Patients with worse recent Eastern Cooperative Oncology Group (ECOG) performance status were more likely to have had a PC consult (p < 0.001). Of the patients who died during the study period, patients with PC consults were more likely to have been hospitalized (72% vs. 47%), in the intensive care unit (21% vs. 0%), in the emergency room (ER) (72% vs. 47%), and have received chemotherapy (17% vs. 0%) within 30 days of death compared with those who did not have a consult; however, these differences were not statistically significant. Conclusion: In this analysis, over half of young adults with advanced solid tumors received PC consults. PC consult typically occurred for one year after diagnosis and about three months before death. Additional research is needed to identify how to better integrate PC early in this patient population and assess the resulting impact.

Benefits of a Nationwide Palliative Care Education Program on Lung Cancer Physicians.

Objective The early integration of palliative care into standard cancer treatment has become a global standard. The Palliative care Emphasis program on symptom management and Assessment for Continuous medical Education (PEACE) has been conducted in Japan, and previous studies have reported that the PEACE workshop was able to improve various palliative care skills of participants. However, whether or not the effects of the program are long-lasting and if the program consequently changed physicians’ practice with regard to lung cancer patients have been unclear. Methods Web-based surveys, including the palliative care knowledge test (PEACE-Q), the Palliative Care self-reported Practice Scale (PCPS), and the Palliative Care Difficulties Scale (PCDS), were conducted among lung cancer physicians in Japan. The differences in the survey results between participants and non-participants of the PEACE workshop were examined. Results Among 923 respondents (455 respiratory physicians, 345 pulmonary surgeons, and 123 others), 519 had participated in the PEACE workshop. The total PEACE-Q score was significantly higher in the PEACE workshop participants than in non-participants (28.0 versus 24.5, p＜0.0001). The score was significantly higher in respiratory physicians than in pulmonary surgeons (27.4 versus 25.5). The total PCPS and PCDS scores were also significantly better in workshop participants than in non-participants (71.8 versus 67.1 and 34.3 versus 36.9, respectively), although some domains of PCDS were similar between the groups. Conclusion The PEACE program improved the knowledge and practices with regard to palliative care and resolved difficulties associated therewith among lung cancer physicians. In regions where palliative care specialists are insufficient, such educational programs may be effective.

Space for intuition – the ‘Surprise’-Question in haemato-oncology: Qualitative analysis of experiences and perceptions of haemato-oncologists

Background: Early integration of palliative care can improve outcomes for people with cancer and non-cancer diagnoses. However, prediction of survival for individuals is challenging, in particular in patients with haematological malignancies who are known to have limited access to palliative care. The ‘Surprise’-Question can be used to facilitate referral to palliative care. Aim: To explore experiences, views and perceptions of haemato-oncologists on the use of the ‘Surprise’-Question in the haemato-oncology outpatients clinics of a university hospital in Germany. Design: A qualitative study using individual semi-structured interviews transcribed verbatim and analysed thematically based on the framework approach. Setting/participants: The study took place at the haemato-oncology outpatient clinic and the bone marrow transplantation outpatient clinic of a university hospital. Nine haemato-oncologists participated in qualitative interviews. Results: Thematic analysis identified 4 themes and 11 subthemes: (1) meaning and relevance of the ‘Surprise’-Question; (2) feasibility; (3) the concept of ‘surprise’ and (4) personal aspects of prognostication. A key function of the ‘Surprise’-Question was to stimulate intuition and promote patient-centred goals of care by initiating a process of pause → reflection → change of perspective. It was easy and quick to use, but required time and communication skills to act on. Participants’ training in palliative care enhanced their willingness to use the ‘Surprise’-Question. Conclusion: Irrespective of its use in prognostication, the ‘Surprise’-Question is a valuable tool to facilitate consideration of patient-centred goals and promote holistic care in haemato-oncology. However, prognostic uncertainty, lack of time and communication skills are barriers for integration into daily practice. Further research should involve haematology patients to integrate their needs and preferences.

A integração precoce dos cuidados paliativos na oncologia pediátrica: um desafio necessário

A integração precoce dos cuidados paliativos na oncologia pediátrica: um desafio necessário

Role of Early Palliative Care in Advanced Head-and-Neck Cancers Patients.

Head-and-neck cancers (HNCs) are significant in India. Poverty, illiteracy, lack of access to healthcare, and poor treatment infrastructure pose a major challenge in the management of these cancers. The majority of these patients present with advanced stage and are not amenable to curative treatment. The majority have the potential to benefit from palliative care (PC) interventions. Our experience has been that usually the referrals from HNC clinic for PC are at the end-of-life or terminal stage. Unfortunately, in the state of intractable suffering, it is difficult for patients to understand and fully benefit from the role of PC. Developing an effective working relationship and communication between the PC service and referring surgeons or oncologists is a key to foster more timely, appropriate referral, as both patients and clinicians often misunderstand or fail to recognize the role of PC. In preparation for a quality improvement project to improve access to PC for HNC patients at the All India Institute of Medical Sciences, we reviewed the needs, challenges, conceptual models, and potential of early integration of PC in advanced HNC patients.

Oncology fellows' current practice regarding concurrent outpatient oncology and palliative care.

122 Background: It is accepted that Palliative Care provides additional support and improves overall care to oncology patients. Literature supports early referral and integration of Palliative Care with standard oncology care and is a guideline from the American Society of Clinical Oncology. In order to make palliative care integration a standard of care, Oncology Fellows should be learning to integrate during their fellowship years. There is little information regarding the Palliative Care experience in the outpatient setting for Oncology Fellows in the United States. This study looked at the current practice model in regards to concurrent Oncology and Palliative Care in the outpatient setting. Methods: An electronic nationwide survey of medical Oncology Fellows was conducted in the second half of the academic year in 2018. Results: 43 of 191, 22.5% Fellows contacted at 17 institutions responded. 98% of the fellows’ hospital systems offered ambulatory palliative care with 79% having a palliative care specialist available during their ambulatory Oncology clinic. 55% of the Fellows’ patient referrals are occurring when they still have multiple lines of cancer directed treatment planned, and the most common initial referral reason is for symptom management. 97% of fellows agree or strongly agree that it is appropriate to refer patients to ambulatory Palliative Care while patients are still undergoing active cancer treatment. 95% indicate they would strongly agree or agree with having a Palliative Care team in their future outpatient clinics. Although no participants stated their initial consult request was for psychosocial and/or spiritual support, 95% strongly agreed or agreed that Palliative Care helps ensure these issues are addressed. Conclusions: Early integration of Palliative Care is occurring in the 17 responding institutions around the country as 97% of Fellows agree or strongly agree that it is appropriate to refer patients to ambulatory Palliative Care while patients are still undergoing active cancer treatment. 95% of oncology fellows indicate they would strongly agree or agree with having a Palliative Care team in their future outpatient clinics.

Establishing a denominator for palliative care quality metrics for patients with advanced cancer.

104 Background: Measurement and feedback of palliative care quality metrics for patients with advanced cancer is an important aspect of supporting a shared mental model for the early integration of palliative care within the oncology clinic. Accurately identifying the subset of advanced cancer patients within a population of cancer patients is critical to the development of quality improvement activities; however, there is not a methodology of identifying these patients in real time. Methods: We evaluated two main approaches to identifying patients with advanced cancer among active cancer patients defined as patients who were seen by an oncologist at least twice in the last 6 months and who had received chemotherapy or radiation at least once in the last two years. These approaches included: 1) Pattern matching of words indicating advanced cancer (e.g. metastatic, advanced) in oncology notes, radiology imaging and problem lists and 2) ICD-10 codes. To determine the final set of ICD-10 codes for the second approach, we used a conceptual model of the meaning of advanced cancer (evidence of distant metastasis and/or poor prognostic cancer with &gt; 50% mortality rate at 5 years) and iterative chart review. In order to test our final definitions, we randomly selected 588 charts of patients with active cancer who see one of 64 oncologists in our health system. These charts were abstracted by an oncologist to establish a gold standard for advanced cancer. We evaluated the sensitivity and specificity of our approaches to identify advanced cancer patients compared to this gold standard. Results: We found that the methods used to identify patients using pattern matching had a specificity of 76% and a sensitivity of 80%. Using our final ICD-10 algorithm we achieved a specificity of 93% and a sensitivity of 68%. We improved our sensitivity to 74% while maintaining our specificity at 92% when we excluded oncologists who predominantly see hematological malignancies. Conclusions: We achieved high specificity and reasonable sensitivity for an advanced cancer quality metric denominator using an ICD-10 algorithm within an academic oncology practice. This will help inform quality improvement efforts locally and beyond.

Residents' attitudes and beliefs towards palliative care in a community teaching hospital.

89 Background: Early integrated palliative care improves the quality of life in patients with cancer. Wong et al. (2016) recently demonstrated that residents and fellows in a university hospital-based large comprehensive cancer center believed palliative care services to be beneficial for patient care. However, there are substantial differences between the clinical learning environments of a university and community teaching hospital. We aim to assess residents' attitudes and beliefs towards palliative care in the oncologic population in a community teaching hospital. Methods: We surveyed all residents (n = 90) in Mercy Catholic Medical Center's internal medicine, transitional year, and general surgery residencies about their knowledge, training, attitudes and beliefs regarding palliative care using a survey modified from Wong et al. (2015). Mercy Catholic Medical Center is a conglomeration of two community teaching hospitals in greater Philadelphia. The factors associated with awareness were analyzed using chi square or fisher exact test and logistic regression. Results: A total of 57 (63%) residents participated. The differences between the knowledge of residents from other specialties were not statistically significant. The awareness was reported more among residents who are American medical graduates (p = 0.03). The majority of the residents believed palliative care was beneficial to patients and families (98%), reduce health care costs (91%), decrease overall symptom burden (86%) and symptomatic management in newly diagnosed cancer (81%). Residents who reported having palliative care training during residency had significantly higher awareness (OR = 2.99, p = 0.04). Conclusions: Our study shows that the attitude and belief of residents at community teaching hospital is similar to the trainees at university teaching hospital. The implementation of palliative care rotation for all residents from clinical specialties can be effective in improving trainee’s attitude and belief regarding increased and early referral to palliative care.

Trends of Palliative Care Utilization in Acute Myeloid Leukemia in the United States

▪Background: Early integration of Palliative Care (PC) have shown to improve survival in some solid malignancies such as lung and colon cancers. In this study we sought to analyze the PC utilization in acute myeloid leukemia (AML) patients.Methods: Using the National Cancer Data Base (NCDB) Participant User File, we extracted patient-level data of patients with AML reported between 2004 to 2015.Patients who received pain management and/or other palliative procedures were considered as PC utilizers. After excluding the cases with acute promyelocytic leukemia t (15, 17) (given its excellent prognosis), we classified the AML into three groups- AML with genetic abnormalities, therapy related AML and AML with dysplasia. Other co-variates included in the analysis were age, sex, race, origin, Charlson-Deyo comorbidity score, insurance status, household income, educational status, facility type (academic vs non-academic) and year of diagnosis. Multivariate logistic regression was performed to identify the predictors of palliative care utilization. Statistical analysis was done using PC SPSS v24.0.Results: Of 102,778 patients, 3.4% (n=3504) received PC as initial treatment. PC utilization increased significantly from 2004-2006 to 2013-2015 (2.5% vs 3.9%, p < 0.001). Individuals of non-Hispanic origin (as compared to that of Hispanics) are more likely to receive PC as compared to that of non-Hispanics. (3.5 vs 1.8%, p<0.001). The patterns of PC utilization at non-academic centers were much higher than that of academic centers (4.4% vs 2.9%, p<0.001). As compared to that of AML, not otherwise specified subtype (3.3%), therapy-related AML (4%) and AML with dysplasia (4.3%) had higher rates of PC utilization, whereas individuals with AML with genetic abnormalities have lesser rates of PC utilization (1.9%) (p<0.001, all comparisons). Significant predictors of PC on multivariable regression are listed in the Table and forest plot.Conclusions: We noticed a differential utilization of palliative care based on the histological subtype of AML. The lesser utilization of PC in AML with certain genetic abnormalities may be attributed to their better overall survival outcomes. Though we noticed an increased trend in PC utilization over the past decade, the overall PC utilization in AML is markedly low and plagued by origin and socio-economic status. DisclosuresNo relevant conflicts of interest to declare.

Palliative Care Practice Patterns among Patients with Lung Cancer Metastatic to the Brain

This study aims to estimate palliative care utilization rates among lung cancer patients with brain metastases, a population for whom improvements in quality of life with early integration of palliative care have been consistently demonstrated. This analysis measured rates of palliative-directed therapy among patients with non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) metastatic to the brain at time of diagnosis from 2010-2014 in the National Cancer Database (NCDB). Palliative-directed therapy is defined in the NCDB as any care with palliative intent including surgical, radiation, medical or pain management interventions. Multivariable logistic regression was used to produce adjusted odds ratios (OR) for factors potentially associated with incorporation of palliative-directed therapy. After propensity score matching, 15,078 patients with and without incorporation of palliative-directed therapy were selected for survival analysis. A total of 67,634 cases met inclusion criteria (80.1% NSCLC, 51.8% male; median age 65 years). At least one palliative-directed therapy was incorporated into the treatment of 22,766 (33.7%) patients, cancer-directed treatment without incorporation of palliative-directed therapy was received by 38,020 (56.2%) patients, and the remaining 6848 (10.1%) patients received no codified treatment. On multivariate analysis, odds of receiving palliative-directed therapy were lower with non-white or black race (OR 0.84; 95% CI 0.77-0.92), absence of comorbidities (OR 0.93; 95% CI 0.88-0.98), and increasing income in a step-wise fashion (reference <$38K: $38K-<48K OR 0.85, 95% CI 0.80-0.89; $48K-<63K OR 0.81, 95% CI 0.77-0.86; ≥$63K OR 0.76, 95% CI 0.71-0.81). Odds of receiving palliative-directed therapy were higher among those living in more educated areas in a step-wise fashion (area residents without high school diploma, reference ≥20%: 13-20% OR 1.19, 95% CI 1.13-1.25; 7-<13% OR 1.33, 95% CI 1.26-1.41; <7% OR 1.36, 95% CI 1.27-1.46). Among only those receiving some codified treatment (n=60,786), incorporation of any palliative-directed therapy had a similar significant inverse correlation with living in wealthier areas and direct correlation with living in more educated areas, as did receipt of palliative-intent radiation. The median survival in months for patients receiving incorporation of palliative-directed therapy versus cancer-directed therapy only was 4.8 (IQR 4.7-5.0) versus 6.8 (IQR 6.6-7.0), respectively. A surprising majority of patients receiving cancer-directed treatment for lung cancer metastatic to the brain have no incorporation of palliative-intent care as codified in the NCDB. This was particularly common for patients living in wealthier and/or less educated areas. This poses an important question of how we are framing our treatment recommendations across various populations.

202 Missed Opportunities: Integrating Palliative Care Into the Emergency Department for Older Adults Presenting as Level 1 Triage Priority from Long-Term Care Facilities

Early integration of palliative care from the emergency department (ED) has been identified as an underutilized modality of care with significant potential benefits, but few studies have addressed how to assess which patients are appropriate for such care. Our hypothesis is that patients 65 years of age or greater who present to the emergency department as a level 1 emergency severity index from a long-term care facility have prolonged hospitalizations with high resource utilization and significant mortality and therefore would benefit from early palliative care involvement. For the years of 2014 and 2015, we performed a retrospective chart review of all patients > 65 years of age that arrived in the emergency department of an academic suburban southeastern Level 1 trauma center from a long-term care facility and were triaged as a Level 1 triage priority, using the Emergency Severity Index. The ED course, hospital course, and final outcomes were analyzed and data collected included code status, mortality, length of stay, level of care, and presence of palliative care intervention. Of the 198 patients in the study population 54% were deceased 30 days after hospital discharge with only 25.7% alive at 15 months. Admitted patients had a mean hospital length of stay of 7 days with 73% requiring intensive care. 40.4% of the patients received a formal palliative care intervention during their hospitalization from either the palliative care consult service (12.1%) or by embedded supportive care nurses (28.3%). Formal palliative care interventions occurred a median of 3 days into hospitalization and often changed the direction of care with 85% of patients downgrading their advanced directive wishes and discharge occurring a median of 1 day after intervention. Few formal palliative care interventions began from the emergency department (9.1%). Interestingly, 47.1% of patients who did not receive any documented goals of care discussions or palliative care interventions were deceased at 15 months post-discharge. Elderly patients from long-term care facilities presenting with severe acute illness have high mortality and seldom receive early palliative care. Introduction of palliative care has the ability to change the course of treatment and improve end-of-life care in this vulnerable population and should be considered early in the hospitalization and where available, be initiated in the emergency department.

Consensus document of the Italian Association of Medical Oncology and the Italian Society of Palliative Care on early palliative care.

A consensus document on early palliative care was produced by a committed Working Group of the Italian Society of Medical Oncology and the Italian Society of Palliative Care to improve the early integration of palliative care in medical oncology and to stimulate and guide the choices of those who daily face the problems of advanced stage cancer patients. The simultaneous administration of antineoplastic treatments and early palliative care was shown to be beneficial in metastatic cancer pathway outcomes. Patients who could benefit from early palliative care are those with an advanced cancer at presentation, a compromised PS for cancer, and/or morbidities, and who are too frail to receive treatment. According to the Bruera practice models, in which the combination of cancer management with early palliative care can be offered, three groups of patients needing simultaneous care were identified and three different models of the delivery of palliative care were proposed. In patients with good prognosis and low need of simultaneous care, the solo practice model and the request for consultations were suggested, while in patients with poor prognosis disease with high need of simultaneous care and in conditions with high need of simultaneous care, regardless of cancer prognosis, the integrated care approach should be offered. Palliative care consultation services are seldom accessible in the majority of Italian hospitals; thus the application of various practice models depends on available resources, and a shared care model with the structures of palliative care operating in the area is often required.

Educate, Nurture, Advise, Before Life Ends\xa0Comprehensive Heartcare for Patients and Caregivers (ENABLE CHF-PC): study protocol for a randomized controlled trial

BackgroundPalliative care is specialized medical care for people with serious illness that is focused on providing relief from symptoms and stress and improving the quality of life (QOL) for patients and their families. To help the 6.5 million U.S. adults and families affected by heart failure manage the high symptom burden, complex decision-making, and risk of exacerbation and death, the early integration of palliative care is critical and has been recommended by numerous professional organizations. However, few trials have tested early outpatient community-based models of palliative care for patients diagnosed with advanced heart failure and their caregivers. To address this gap, through a series of formative evaluation trials, we translated an oncology early palliative care telehealth intervention for heart failure to create ENABLE CHF-PC (Educate, Nurture, Advise, Before Life Ends, Comprehensive Heartcare for Patients and Caregivers).Methods/DesignThe primary objective of this multisite pragmatic randomized controlled trial is to test the efficacy of ENABLE CHF-PC plus usual heart failure care compared to usual care alone. Community-dwelling persons who are ≥50 years of age with New York Heart Association class III/IV or American Heart Association/American College of Cardiology stage C/D heart failure and their primary caregiver (if present) are being randomized to one of two study arms. The ENABLE CHF-PC intervention group receives usual heart failure care plus an in-person palliative care assessment by a board-certified palliative care provider (caregivers are invited to attend), a series of nurse coach-led, weekly psychoeducational 20 to 60 min phone sessions using a guidebook called Charting Your Course (patients: 6 sessions and caregivers: 4 sessions), and monthly check-in calls. Charting Your Course topical content includes problem-solving, coping, self-care and symptom management, communication, decision-making, advance care planning, and life review (patients only). Primary outcomes include patient QOL and mood (depressive symptoms/anxiety) and caregiver QOL, mood, and burden at 8 and 16 weeks after baseline. Outcomes will be examined using an intention-to-treat approach and mixed effects modeling for repeated measures.DiscussionThis trial will determine whether the ENABLE CHF-PC model of concurrent heart failure palliative care is superior to usual heart failure care alone in achieving higher patient and caregiver QOL, improving mood, and lowering burden.Trial registration ClinicalTrials.gov, NCT02505425. Registered on 22 July 2015.

Demystification of palliative care: what palliative care teams don't want you to think about them.

SummaryThere is robust data that palliative care is prolonging life while there are still prejudices towards this discipline that have to be demystified. Patients, relatives and caregivers benefit from the concept of early integration of palliative care and therefore, palliative care should not be mainly regarded as end-of-life care.

Abstract 1641: Utilization of palliative therapies among Hispanics with stage IV non-small cell lung cancer

Abstract Background: Racial disparities in the treatment of lung cancer are well documented. However, research in disparities in palliative care is limited. Early integration of palliative care in advanced non-small cell lung cancer (NSCLC) has been proven to improve quality of life and overall survival in this subset of patients. We proposed to study the use of palliative treatments for stage IV NSCLC among Hispanic patients (pts). Methods: Using the National Cancer Database (NCDB), we identified all Hispanic pts (self-reported) diagnosed with stage IV NSCLC from 2005 to 2013. Cases with incomplete data, unknown life/death status or classified as Hispanic by surname only were excluded. Hispanics were grouped based on place of origin. Pearson chi-square tests were used to estimate differences in categorical data; predictors of palliative care referral/use were determined by logistic regression analysis. Results: 10,441 pts were included. The median age was 66 years. Regarding place of origin: 15.5% of pts were from Mexico, 8% from South/Central America, 7% from Cuba, 6% from Puerto Rico, 2.4% from the Dominican Republic and 57.6% were no-otherwise specified. When all Hispanic pts were included, 3.5% received surgery, 45% radiation and 52.9% chemotherapy. Overall, 2.2% of pts received a referral for palliative pain management +/- other palliative therapies. When divided by place of origin, Dominican pts had the highest percentage of pain management referrals at 5.5% (p&amp;lt;0.01) followed by Puerto Rican patients (2.4%). On the other hand, only 1.3% of pts from South/Central America were referred to pain management. In multivariate analysis, Dominican Republic origin (OR: 3.30, 95%CI: 1.69-6.44, p&amp;lt;0.01), bone metastasis (OR: 1.98, 95%CI: 1.17-3.3, p&amp;lt;0.01) and a Charlson comorbidity index ≥2 (OR: 2.07, 95%CI: 1.11-3.85, p&amp;lt;0.02) were significant predictors of receiving a pain management referral. We observed an increased number of pain management referrals over time with 1.4% of Hispanic patients getting a referral in 2004 vs. 2.9% in 2013 (p&amp;lt;0.02). Conclusions: We observed that only a small percentage of Hispanic pts with metastatic NSCLC cancer are receiving referral for palliative care/pain management. Several cultural beliefs and barriers may play a role in these findings. Providers should offer early referrals to pain management/palliative care to all patients with metastatic NSCLC independent of their race or ethnicity. Citation Format: Narjust Duma, Urshila Durani, Julian Molina, Timothy J. Moynihan. Utilization of palliative therapies among Hispanics with stage IV non-small cell lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1641.

Inpatient Palliative Care Consultations From a Canadian Clinical Teaching Unit: Who is Referred and When?

Inpatient palliative care consultation has been demonstrated to improve quality of life as well as decrease hospital readmissions, intensive care unit transfers, and hospital costs for people with a life limiting illness. The clinical teaching units (CTUs) at London Health Sciences Centre (LHSC) routinely admit patients with noncurable cancer as well as end-stage heart, lung, liver, or kidney disease. However, the use of inpatient palliative care consultations for CTU patients remains unexamined. We conducted a descriptive study of all patients referred from LHSC CTU from both University and Victoria hospital to inpatient palliative care over a 1-year period from August 2013 to July 2014. The purpose of this study was to characterize the population and identify possible areas for quality improvement. In a 1-year period, 638 patients were referred from CTU to the inpatient palliative care consultation service. Of referrals, 55% died during their admission. Based on data collected, we conclude that many patients are referred early in their admission to CTU and patients are referred for a variety of noncancer diseases, suggesting knowledge and appreciation of the benefit of early palliative care consultation for malignant and nonmalignant disease. However, when further analyzed, there is indication that patients with noncancer diagnoses are referred statistically significantly later than those with a cancer diagnosis. The CTUs are sites of core medical training, and therefore, it is imperative that we model early integration of palliative care in order to continue to improve care of patients at end of life.

Barriers to early integration of palliative care: A qualitative analysis of medical oncologist attitudes and practice patterns.

e22191Background: Early integration of palliative care for patients with advanced cancer has demonstrable benefits but is underutilized. We sought to characterize medical oncologists’ perspectives ...