Palliative Care Consultation Associated With Less Aggressive End-of-Life Care in Advanced Pancreas Cancer
In a study reported in the Journal of the National Cancer Institute, Jang et al found that palliative care consultation was associated with decreased use of chemotherapy near death and lower risks of ICU admission, multiple emergency department visits, and multiple hospitalizations near death in patients with advanced pancreas cancer.
The study was a retrospective population-based cohort analysis using administrative data from 5,381 patients with advanced pancreatic cancer in Ontario from 2005 to 2010. Patients had a median survival of 75 days.
Reduction in Aggressive Care
Overall, 2,816 patients (52.3%) had received a palliative care consultation. Palliative care consultation was associated with decreased use of chemotherapy within 14 days of death (odds ratio [OR] = 0.34, 95% confidence interval [CI] = 0.25–0.46) and lower risks of ICU admission (OR = 0.12, 95% CI = 0.08–0.18), multiple emergency department visits (OR = 0.19, 95% CI = 0.16–0.23), and multiple hospitalizations near death (OR = 0.24, 95% CI = 0.19–0.31).
Increased Reduction With Increased Visits
Each per-unit increase in monthly rate of palliative care visits was associated with lower risk of aggressive care for all four outcomes: ORs = 0.69 (95% CI = 0.58–0.81) for chemotherapy near death, 0.31 (95% CI = 0.21–0.46) for ICU admission, 0.31 (95% CI = 0.26–0.38) for multiple emergency department visits, and 0.31 (95% CI = 0.24-0.40) for multiple hospitalizations.
The investigators concluded: “[Palliative care] consultation and a higher intensity of [palliative care] were associated with less aggressive care near death in patients with advanced pancreatic cancer.”
Raymond W. Jang, MD, of Princess Margaret Cancer Centre, is the corresponding author for the Journal of the National Cancer Institute article.
The study was supported by the Conquer Cancer Foundation of the American Society of Clinical Oncology, University of Toronto Medical Oncology Postgraduate Ontario Student Opportunity Trust Funds, and Princess Margaret Cancer Centre University Health Network.
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®.
