Access to Palliative Care Among Patients Treated at a Comprehensive Cancer Center |
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| Authors: | David Hui Sun‐Hyun Kim Jung Hye Kwon Kimberson Cochien Tanco Tao Zhang Jung Hun Kang Wadih Rhondali Gary Chisholm Eduardo Bruera |
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| Affiliation: | 1. aDepartment of Palliative Care and Rehabilitation Medicine,;2. dDepartment of Family Medicine, Myong Ji Hospital, Kwandong University, College of Medicine, Gyeonggi, Republic of Korea;3. eDepartment of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Chuncheon, South Korea;4. bClinical Analytics & Informatics,;5. fDepartment of Internal Medicine, Institute of Health Science, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea;6. cDepartment of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA |
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| Abstract: | Background.Palliative care (PC) is a critical component of comprehensive cancer care. Previous studies on PC access have mostly examined the timing of PC referral. The proportion of patients who actually receive PC is unclear. We determined the proportion of cancer patients who received PC at our comprehensive cancer center and the predictors of PC referral.Methods.We reviewed the charts of consecutive patients with advanced cancer from the Houston region seen at MD Anderson Cancer Center who died between September 2009 and February 2010. We compared patients who received PC services with those who did not receive PC services before death.Results.In total, 366 of 816 (45%) decedents had a PC consultation. The median interval between PC consultation and death was 1.4 months (interquartile range, 0.5–4.2 months) and the median number of medical team encounters before PC was 20 (interquartile range, 6–45). On multivariate analysis, older age, being married, and specific cancer types (gynecologic, lung, and head and neck) were significantly associated with a PC referral. Patients with hematologic malignancies had significantly fewer PC referrals (33%), the longest interval between an advanced cancer diagnosis and PC consultation (median, 16 months), the shortest interval between PC consultation and death (median, 0.4 months), and one of the largest numbers of medical team encounters (median, 38) before PC.Conclusions.We found that a majority of cancer patients at our cancer center did not access PC before they died. PC referral occurs late in the disease process with many missed opportunities for referral. |
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| Keywords: | Health services Neoplasms Palliative care Quality of health care Referral and consultation |
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