Meeting News CoveragePerspective

Oncology, palliative care partnership reduced patients’ lengths of stay, readmission rates

A “co-rounding” partnership between medical oncologists and palliative care specialists on an inpatient oncology ward was associated with shorter hospital lengths of stay and reduced readmission rates, according to results of a retrospective cohort analysis presented at the Palliative Care in Oncology Symposium.

“The concept that cancer care is optimized through the integration of palliative care is one that is increasingly and widely endorsed,” researcher Richard Riedel, MD, associate professor of medicine and medical director of the inpatient solid tumor service at Duke University Medical Center, said during a press conference. “The early integration of palliative care allows one to address quality-of-life issues and symptom management throughout the trajectory of one’s disease course. Current data supports the benefit of palliative care integration in the outpatient realm, as well as part of a consultative service in the hospital-based setting. The benefits of integrating palliative care on an inpatient oncology ward with daily assessments is unknown.”

Riedel and colleagues implemented the novel partnership program — which included three formal daily meetings to discuss all patients in the unit — to assess the impact of early palliative care on patients with advanced cancer. Patients were assigned a palliative care specialist or medical oncologist as their attending physician according to their specific needs and symptom burden.

“The model fosters open communication and collaboration through standardized touchdown points throughout the day, where the teams will physical meet with both the medical oncology and palliative care attending in attendance, and each patient will be discussed so there can be input from each specialty,” Riedel said.

The analysis included data from 731 patients admitted to the solid tumor inpatient service before the intervention, and 783 who were admitted after the partnership had been implemented. Those who were treated pre- and post-intervention were similar with regard to mean age (61 years vs. 62 years; P=.07), gender (male, 51% vs. 48%; P=.22) and race (non-Hispanic white, 68% vs. 71%; P=.39). A similar proportion of patients in each cohort received Medicare (49% vs. 51%; P=.96) and had recurrent/metastatic disease (73% vs. 74%; P=.6).

The mean hospital length of stay decreased from 4.51 days to 4.17 days after the intervention (P=.02).

The program also was associated with a 23% reduction in 7-day readmission rates (P=.03), and a 12% reduction in 30-day readmission rates (P=.05).

Researchers observed a 17% increase hospice referrals (P=.09), as well as a 15% decrease in ICU transfers after the program’s implementation (P=.64).

“Leveraging the skill set of both palliative care physicians and medical oncologists has allowed us to better manage symptoms, shorten hospital stays and prevent readmissions,” Riedel said in a press release. “We’ve also been able to dispel any misconceptions that individuals may have had about the role of palliative care, and we’ve shown that nursing and physician impressions of palliative care, as a whole, are very favorable.”

For more information:

Riedel RF. Abstract #3. Scheduled for presentation at: Palliative Care in Oncology Symposium; Oct. 24-25, 2014; Boston.

Disclosure: Riedel reports a consultant/advisory role with and travel expenses, research funding and honoraria from Ariad, Astex Therapeutics, CytRx Corporation, Eisai, GlaxoSmithKline, Merck, Morphotek, Novartis, Threshold Pharmaceuticals, Tracon and Ziopharm. One of his immediate family members is employed with BioTech Prosthetics and Orthotics and receives royalties on patents licensed to PandoNet — Limbguard. One other researcher reports honoraria and research funding from Celgene and Helsinn Therapeutics.

A “co-rounding” partnership between medical oncologists and palliative care specialists on an inpatient oncology ward was associated with shorter hospital lengths of stay and reduced readmission rates, according to results of a retrospective cohort analysis presented at the Palliative Care in Oncology Symposium.

“The concept that cancer care is optimized through the integration of palliative care is one that is increasingly and widely endorsed,” researcher Richard Riedel, MD, associate professor of medicine and medical director of the inpatient solid tumor service at Duke University Medical Center, said during a press conference. “The early integration of palliative care allows one to address quality-of-life issues and symptom management throughout the trajectory of one’s disease course. Current data supports the benefit of palliative care integration in the outpatient realm, as well as part of a consultative service in the hospital-based setting. The benefits of integrating palliative care on an inpatient oncology ward with daily assessments is unknown.”

Riedel and colleagues implemented the novel partnership program — which included three formal daily meetings to discuss all patients in the unit — to assess the impact of early palliative care on patients with advanced cancer. Patients were assigned a palliative care specialist or medical oncologist as their attending physician according to their specific needs and symptom burden.

“The model fosters open communication and collaboration through standardized touchdown points throughout the day, where the teams will physical meet with both the medical oncology and palliative care attending in attendance, and each patient will be discussed so there can be input from each specialty,” Riedel said.

The analysis included data from 731 patients admitted to the solid tumor inpatient service before the intervention, and 783 who were admitted after the partnership had been implemented. Those who were treated pre- and post-intervention were similar with regard to mean age (61 years vs. 62 years; P=.07), gender (male, 51% vs. 48%; P=.22) and race (non-Hispanic white, 68% vs. 71%; P=.39). A similar proportion of patients in each cohort received Medicare (49% vs. 51%; P=.96) and had recurrent/metastatic disease (73% vs. 74%; P=.6).

The mean hospital length of stay decreased from 4.51 days to 4.17 days after the intervention (P=.02).

The program also was associated with a 23% reduction in 7-day readmission rates (P=.03), and a 12% reduction in 30-day readmission rates (P=.05).

Researchers observed a 17% increase hospice referrals (P=.09), as well as a 15% decrease in ICU transfers after the program’s implementation (P=.64).

“Leveraging the skill set of both palliative care physicians and medical oncologists has allowed us to better manage symptoms, shorten hospital stays and prevent readmissions,” Riedel said in a press release. “We’ve also been able to dispel any misconceptions that individuals may have had about the role of palliative care, and we’ve shown that nursing and physician impressions of palliative care, as a whole, are very favorable.”

For more information:

Riedel RF. Abstract #3. Scheduled for presentation at: Palliative Care in Oncology Symposium; Oct. 24-25, 2014; Boston.

Disclosure: Riedel reports a consultant/advisory role with and travel expenses, research funding and honoraria from Ariad, Astex Therapeutics, CytRx Corporation, Eisai, GlaxoSmithKline, Merck, Morphotek, Novartis, Threshold Pharmaceuticals, Tracon and Ziopharm. One of his immediate family members is employed with BioTech Prosthetics and Orthotics and receives royalties on patents licensed to PandoNet — Limbguard. One other researcher reports honoraria and research funding from Celgene and Helsinn Therapeutics.

    Perspective
    Jyoti D. Patel

    Jyoti D. Patel

    Certainly, integration of palliative care into oncology is the definition of good oncology care. This novel paradigm of “co-rounding” has had impressive results in this study. The model is an exciting one, because so often patients who are admitted to the solid tumor service are experiencing extraordinary toxicity from therapy, have significant disease progression, and are very symptomatic or have few reasonable treatment options left.

    Integration at every step of the way, from admission to disposition planning, addresses symptoms early on. It requires the house staff and fellows to start asking how we can best support these patients in the entire trajectory, and teaches the house staff how to have these conversations. I think the integration helps for unity in terms of goals of care, and our palliative oncology colleagues often provide significant insight as to how to best manage symptoms. Having the conversation with multiple people makes your focus on the whole patient.

    • Jyoti D. Patel, MD
    • Thoracic oncologist Northwestern University Feinberg School of Medicine

    Disclosures: Patel reports research funding from Astex Therapeutics, Genentech, Lilly and Novartis.