James D. Murphy, MD, MS
End-of-life palliative care consultations can significantly reduce healthcare utilization, according to a broad-based population study published in the Journal of Oncology Practice
(JOP). The authors said the study supports the findings of various smaller studies.
The study drew on Medicare claims information from the National Cancer Institute’s Surveillance, Epidemiology, and End Results Medicare database (aka, SEER). It found that, following palliative care consultation, 54% of patients were less likely to receive chemotherapy, 35% were less likely to start a new chemotherapy regimen, and 24% were more likely to enroll in hospice care.
“It’s critically important to validate research in a real-world setting,” said study author James Murphy, MD, MS, University of California, San Diego. “Using a representative and diverse cohort of patients, our study shows the practical benefits of palliative care as it is actually implemented in an everyday practice setting.”
The study examined data on 6580 patients with metastatic prostate, breast, lung and colorectal cancer, comparing healthcare utilization rates among those who received palliative care consultations and those who did not. Patients who received palliative care consultations did so a median of 12 days before death (range, 4-38 days), the study found. Among patients who received consultations, there were reductions in use of emergency departments and intensive care units, as well as fewer invasive procedures and shorter hospital stays in general.
The authors concluded that palliative care conversations between patients and healthcare teams represent an “inflection point” that demarcates a boundary between high healthcare utilization and lower healthcare utilization. Interestingly, the study also found that patients on the West Coast were more likely to undergo palliative care consultations as they neared the end of life than patients with cancer elsewhere.
Palliative care involves managing, preventing, and relieving the symptoms of cancer and the side effects of cancer treatment, as well as providing comprehensive support for the patient’s family, friends, and caregivers.
More hospitals these days are offering palliative care programs, which signifies a growing faith in the value of this service. In 2000, just a quarter of hospitals had a palliative care program, whereas by 2011 the figure exceeded two-thirds of the total, according to ASCO, which announced the JOP study.
The authors said total healthcare utilization was lower for patients who had palliative care consultations earlier in disease progression. “Given the increasing number of older patients with advanced cancer, this study provides important context for the need of early integration of palliative care in oncology,” Murphy said.
Indeed, ASCO’s guideline on palliative care recommends that patients with advanced cancer—both inpatients and outpatients—receive dedicated palliative care services early in the disease course and concurrent with active treatment.
Previous studies have documented the many benefits for those who receive palliative care. These include increased satisfaction, improved quality of life, and even extended survival. ASCO said introducing palliative care sooner after diagnosis also helps patients better understand their prognosis and goals of treatment, manage their expectations, and maintain their quality of life.
The study did not offer information about healthcare professionals who initiated the palliative care consultations. The authors noted that knowing more about the content of consultations and the palliative care teams who lead those discussions—physicians, nurses, social workers, pharmacists, and spiritual counselors—could shed light on what drives utilization behaviors among patients.
Triplett DP, LeBrett WG, Bryant AK, et al. Effect of palliative care on aggressiveness of end-of-life care among patients with advanced cancer [published online August 22, 2017]. J Oncol Pract. doi:10.1200/JOP.2017.020883.