In the Journals

Early referral to outpatient palliative care improved end-of-life care

Adult patients with advanced cancer who were referred early to outpatient palliative care experienced better end-of-life care compared with patients who received inpatient palliative care, according to study results.

David Hui, MD, MSc, of the department of palliative care and rehabilitation medicine at The University of Texas MD Anderson Cancer Center, and colleagues evaluated data from 366 patients who died of advanced cancer from 2009 to 2010.

David Hui, MD, MSc 

David Hui

All patients received a palliative care consultation, and 120 (33%) had an early referral, defined as longer than 3 months before death. Nearly half of the patients (n=169; 46%) first received outpatient palliative care.

Researchers found patients who received early palliative care experienced fewer ED visits (39% vs. 68%; P˂.001), hospitalizations (48% vs. 81%; P˂.003) and hospital deaths (17% vs. 31%; P=.004) in the last 30 days of life compared with patients with later referrals.

Fewer patients who received outpatient vs. inpatient palliative care experienced ED visits (48% vs. 68%; P˂.001), hospital admissions (52% vs. 86%; P˂.001),hospital deaths (18% vs. 34%; P=.001) and ICU admissions (4% vs. 14%; P=.001).

Multivariate analyses indicated a referral for outpatient palliative care was independently associated with less aggressive end-of-life care (OR=0.42; 95% CI, 0.28-0.66).

More aggressive end-of-life care was more common among males (OR=1.63; 95% CI, 1.06-2.50) and patients with hematologic malignancies (OR=2.57; 95% CI, 1.18-5.59).

“Patients who were referred to outpatient palliative care had improved end-of-life care compared with those who received inpatient palliative care,” the study said. “The current findings support the need to increase the availability of palliative care clinics and to streamline the process of early referral.”

In an interview with HemOnc Today, Hui noted “patients with hematologic malignancies were much less likely to receive palliative care. This study highlights an important gap in care for patients with hematologic malignancies.”

“Clinical practice guidelines for hematological malignancies should include guidance to limit aggressive cancer treatments at the end-of-life and encourage early referral to palliative care. Hematologic oncologists may want to engage in end-of-life discussions with their patients more often, discussing prognosis, care plans and goals of care,” Hui said. — by Reagan Copeland

 Disclosure: See the study for a full list of the researchers’ relevant financial disclosures.