Effect of Embedding Palliative Care in an Oncology Clinic

Key Points

  • An embedded palliative care program resulted in earlier and prolonged access to palliative care.
  • More patients enrolled in hospice at > 7 days before death.

A retrospective analysis reported in the Journal of Oncology Practice by Einstein et al showed the benefits of embedding palliative care in a clinic specializing in targeted and immune-based treatments in patients with melanoma or renal cancer.

Study Details

The study included data from 114 patients who died in the 3 years after implementation of the embedded palliative care model. In the intervention, patients seen on a particular day had access to the embedded model featuring a palliative care team based on the automatic criteria of diagnosis of stage IV or metastatic kidney cancer or melanoma, receipt of active anticancer therapy, or a self-assessed Edmonton Symptom Assessment Scale score > 5 on one or more individual symptoms. Patients seen on other days could be referred to a separate palliative care clinic (usual care).

Outcomes

Compared with 88 patients receiving usual care, 26 patients seen in the embedded model accessed palliative care as outpatients more often (90% vs 73%, P = .003) and earlier before death (mean = 231 vs 109 days before death, P < .001). Hospice enrollment rates were similar (58% vs 51%, P = .303), but the mean duration of hospice was increased (57 vs 25 days, P = .006); enrollment in hospice > 7 days before death was also significantly increased (50% vs 28%, odds ratio = 5.60, P = .034). Place of death (P = .505) and chemotherapy within 2 weeks of death (8% vs 14%, odds ratio = 0.361, P = .204) did not differ between the groups.

The investigators concluded: “A model of embedded and automatically triggered palliative care among patients treated exclusively with targeted and immune-based therapies was associated with significant improvements in use and timing of palliative care and hospice, compared with usual practice.”

The study was supported by the Center for Healthcare Delivery Science, Brigham and Women’s Hospital, and Harvard Medical School.

David J. Einstein, MD, of Beth Israel Deaconess Medical Center, is the corresponding author of the Journal of Oncology Practice article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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