Up-Front Palliative Care Consultation Associated With Better Outcomes in Advanced Cancer

June 03, 2017

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 (http://abstracts.asco.org/199/AbstView_199_190938.html).

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).

Upon adjusting for gender, age, race, and encounter type, patients receiving up-front consultation had higher risk of mortality (52% versus 47%; p = 0.03). There were no differences 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), less 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).

“Our data provides additional evidence for the benefits of earlier specialist palliative care consultation services, including [in] patients traditionally identified as underserved,” the authors concluded.

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