Optimal timing for the initiation of specialist palliative care has not been determined. In a study, researchers created a supportive oncology inpatient service that integrates up-front palliative care consultation for certain patients with advanced cancer and compared it to those receiving usual oncologic care with on-demand palliative care consultation. The study’s findings were presented at the ASCO Annual Meeting.
The retrospective, cohort study enrolled 809 patients between January 2015 and December 2015 to receive the up-front care (n = 468) or on-demand care (n = 341). They examined length of stay, cost, and 30-day readmission rate associated with each inpatient care option.
The researchers found that compared to patients receiving on-demand palliative care consultation, those receiving up-front services were significantly younger (age = 61.1 ± 13.2 versus 63.3 ± 13.0 years; p = 0.02), more likely to be female (50% versus 40%; p = 0.005), and more likely to be African American (47% versus 35%; p = 0.005).
After adjusting for gender, age, race, and encounter type, researchers found that patients receiving up-front consultation had higher risk of mortality (52% versus 47%; p = 0.03). No differences were found in All Patient Refined Diagnosis Related Groups weight (p = 0.30) or severity scores (p = 0.34).
Up-front consultation was associated with significantly lower costs ($12,050 versus $15,990; p = 0.003), fewer 30-day readmissions (16% versus 23%; p = 0.03), and a trend toward shorter length of stay (5.6 ± 4.9 days versus 6.2 ± 6.5; p = 0.10).
ONS’s position statement on implementing palliative care at diagnosis for people with cancer agrees with the study findings.