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Factors associated with palliative care referral among patients with advanced cancers: a retrospective analysis of a large Brazilian cohort

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Abstract

Purpose

The purpose of the study is to estimate the proportion of patients who had access to palliative care (PC) and to identify the timing and factors associated with this access.

Methods

A retrospective longitudinal study that included patients who died of advanced cancer between the years of 2010 and 2014 was conducted. The proportion of patients who received PC consultations was compared during those years. Sociodemographic and clinical factors, the timing between first PC consultation and death (early, ≥ 3 months; late, < 3 months), and first PC consultation were assessed.

Results

Of the 1284 studied patients, 988 (76.9%) were referred to PC and 839 (65.3%) had a PC consultation. The proportion of patients who received late PC consultation increased between the years 2010 and 2014 (44.2 vs. 60.4%, p = 0.001). Multivariate analysis revealed that younger age (odds ratio (OR) = 0.98, p = 0.016) and gynecologic cancer (OR = 2.17, p = 0.011) were associated with a PC consultation. Upper gastrointestinal tract (GIT) cancer (OR = 2.42, p = 0.001) and hematologic malignancies (OR = 0.37, p = 0.001) were associated with late PC consultations. The median time interval between the first PC consultation and death was 2.66 months: timing differed significantly among cancer subtypes (p = 0.002).

Conclusion

Most patients received PC consultation before death, and the number of patients with late consultation increased throughout the study. Patients with late referrals could have received PC earlier. The current findings suggest the need to standardize the referral criteria to optimize access to PC.

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References

  1. World Health Organization. WHO (2014) Global Atlas of Palliative Care at the End of Life. http://www.who.int/nmh/Global_Atlas_of_Palliative_Care.pdf. Accessed 15 March 2017

  2. Bakitas MA, Tosteson TD, Li Z, Lyons KD, Hull JG, Li Z, Dionne-Odom JN, Frost J, Dragnev KH, Hegel MT, Azuero A, Ahles TA (2015) Early versus delayed initiation of concurrent palliative oncology care: patient outcomes in the ENABLE III randomized controlled trial. J Clin Oncol Off J Am Soc Clin Oncol 33(13):1438–1445. https://doi.org/10.1200/JCO.2014.58.6362

    Article  Google Scholar 

  3. Nickolich MS, El-Jawahri A, Temel JS, LeBlanc TW (2016) Discussing the evidence for upstream palliative care in improving outcomes in advanced cancer. Am Soc Clin Oncol Educ B Am Soc Clin Oncol Meet 35:e534–e538. https://doi.org/10.14694/EDBK_159224

    Article  Google Scholar 

  4. Temel JS, Greer JA, Admane S, Gallagher ER, Jackson VA, Lynch TJ, Lennes IT, Dahlin CM, Pirl WF (2011) Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: results of a randomized study of early palliative care. J Clin Oncol Off J Am Soc Clin Oncol 29(17):2319–2326. https://doi.org/10.1200/JCO.2010.32.4459

    Article  Google Scholar 

  5. Bakitas M, Lyons KD, Hegel MT, Balan S, Brokaw FC, Seville J, Hull JG, Li Z, Tosteson TD, Byock IR, Ahles TA (2009) Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the project ENABLE II randomized controlled trial. JAMA 302(7):741–749. https://doi.org/10.1001/jama.2009.1198

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363(8):733–742. https://doi.org/10.1056/NEJMoa1000678

    Article  CAS  PubMed  Google Scholar 

  7. Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A, Moore M, Rydall A, Rodin G, Tannock I, Donner A, Lo C (2014) Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet 383(9930):1721–1730. https://doi.org/10.1016/S0140-6736(13)62416-2

    Article  PubMed  Google Scholar 

  8. Smith TJ, Temin S, Alesi ER, Abernethy AP, Balboni TA, Basch EM, Ferrell BR, Loscalzo M, Meier DE, Paice JA, Peppercorn JM, Somerfield M, Stovall E, Von Roenn JH (2012) American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J Clin Oncol Off J Am Soc Clin Oncol 30(8):880–887. https://doi.org/10.1200/JCO.2011.38.5161

    Article  Google Scholar 

  9. Hui D, Cerana MA, Park M, Hess K, Bruera E (2016) Impact of oncologists’ attitudes toward end-of-life care on patients’ access to palliative care. Oncologist 21(9):1149–1155. https://doi.org/10.1634/theoncologist.2016-0090

    Article  PubMed  PubMed Central  Google Scholar 

  10. Yoong J, Park ER, Greer JA, Jackson VA, Gallagher ER, Pirl WF, Back AL, Temel JS (2013) Early palliative care in advanced lung cancer: a qualitative study. JAMA Intern Med 173(4):283–290. https://doi.org/10.1001/jamainternmed.2013.1874

    Article  PubMed  Google Scholar 

  11. Rangachari D, Smith TJ (2013) Integrating palliative care in oncology: the oncologist as a primary palliative care provider. Cancer J 19(5):373–378. https://doi.org/10.1097/PPO.0b013e3182a76b9c

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hui D, Kim SH, Roquemore J, Dev R, Chisholm G, Bruera E (2014) Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients. Cancer 120(11):1743–1749. https://doi.org/10.1002/cncr.28628

    Article  PubMed  Google Scholar 

  13. Hui D, Kim SH, Kwon JH, Tanco KC, Zhang T, Kang JH, Rhondali W, Chisholm G, Bruera E (2012) Access to palliative care among patients treated at a comprehensive cancer center. Oncologist 17(12):1574–1580. https://doi.org/10.1634/theoncologist.2012-0192

    Article  PubMed  PubMed Central  Google Scholar 

  14. Dos-Anjos CS, Candido PB, Rosa VD, Costa RE, Neves FR, Junqueira-Santos AF, De-Carlo MM, Peria FM, Lima NK (2017) Assessment of the integration between oncology and palliative care in advanced stage cancer patients. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 25(6):1837–1843. https://doi.org/10.1007/s00520-017-3588-9

    Article  Google Scholar 

  15. The Economist Intelligence Unit (2015) The 2015 Quality of Death Index Ranking palliative care across the world. https://www.eiuperspectives.economist.com/sites/default/files/2015%20EIU%20Quality%20of%20Death%20Index%20Oct%2029%20FINAL.pdf. Accessed 5 April 2017

  16. Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39(2):175–191. https://doi.org/10.3758/BF03193146

    Article  PubMed  Google Scholar 

  17. Hui D, Mori M, Watanabe SM, Caraceni A, Strasser F, Saarto T, Cherny N, Glare P, Kaasa S, Bruera E (2016) Referral criteria for outpatient specialty palliative cancer care: an international consensus. Lancet Oncol 17(12):e552–e559. https://doi.org/10.1016/S1470-2045(16)30577-0

    Article  PubMed  Google Scholar 

  18. Dalal S, Bruera S, Hui D, Yennu S, Dev R, Williams J, Masoni C, Ihenacho I, Obasi E, Bruera E (2016) Use of palliative care services in a tertiary cancer center. Oncologist 21(1):110–118. https://doi.org/10.1634/theoncologist.2015-0234

    Article  PubMed  Google Scholar 

  19. Amano K, Morita T, Tatara R, Katayama H, Uno T, Takagi I (2015) Association between early palliative care referrals, inpatient hospice utilization, and aggressiveness of care at the end of life. J Palliat Med 18(3):270–273. https://doi.org/10.1089/jpm.2014.0132

    Article  PubMed  Google Scholar 

  20. Bennett MI, Ziegler L, Allsop M, Daniel S, Hurlow A (2016) What determines duration of palliative care before death for patients with advanced disease? A retrospective cohort study of community and hospital palliative care provision in a large UK city. BMJ Open 6(12):e012576. https://doi.org/10.1136/bmjopen-2016-012576

    Article  PubMed  PubMed Central  Google Scholar 

  21. Faguet GB (2016) Quality end-of-life cancer care: an overdue imperative. Crit Rev Oncol Hematol 108:69–72. https://doi.org/10.1016/j.critrevonc.2016.10.012

    Article  PubMed  Google Scholar 

  22. Harrington SE, Smith TJ (2008) The role of chemotherapy at the end of life: “when is enough, enough?”. JAMA 299(22):2667–2678. https://doi.org/10.1001/jama.299.22.2667

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Rugno FC, Paiva BS, Nunes JS, Paiva CE (2014) “There won’t be anything else...it’s over”: perceptions of women referred to palliative care only. Eur J Oncol Nurs Off J Eur Oncol Nurs Soc 18(3):261–266. https://doi.org/10.1016/j.ejon.2014.01.003

    Article  Google Scholar 

  24. Lowe SS, Nekolaichuk C, Ghosh S, Fainsinger L, Quan H, Fainsinger R (2016) Clinical characteristics of patients having single versus multiple patient encounters within a palliative care programme. BMJ Support Palliat Care. https://doi.org/10.1136/bmjspcare-2015-000985

    Article  Google Scholar 

  25. Hui D, Didwaniya N, Vidal M, Shin SH, Chisholm G, Roquemore J, Bruera E (2014) Quality of end-of-life care in patients with hematologic malignancies: a retrospective cohort study. Cancer 120(10):1572–1578. https://doi.org/10.1002/cncr.28614

    Article  PubMed  Google Scholar 

  26. LeBlanc TW, El-Jawahri A (2015) When and why should patients with hematologic malignancies see a palliative care specialist? Hematology Am Soc Hematol Educ Program 2015(1):471–478. https://doi.org/10.1182/asheducation-2015.1.471

    Article  PubMed  Google Scholar 

  27. Lefkowits C, Teuteberg W, Courtney-Brooks M, Sukumvanich P, Ruskin R, Kelley JL (2015) Improvement in symptom burden within one day after palliative care consultation in a cohort of gynecologic oncology inpatients. Gynecol Oncol 136(3):424–428. https://doi.org/10.1016/j.ygyno.2014.12.030

    Article  PubMed  Google Scholar 

  28. Landrum LM, Blank S, Chen LM, Duska L, Bae-Jump V, Lee PS, Levine L, McCourt C, Moore KN, Urban RR (2015) Comprehensive care in gynecologic oncology: the importance of palliative care. Gynecol Oncol 137(2):193–202. https://doi.org/10.1016/j.ygyno.2015.02.026

    Article  PubMed  Google Scholar 

  29. Bergman J, Laviana AA (2016) Opportunities to maximize value with integrated palliative care. J Multidiscip Healthc 9:219–226. https://doi.org/10.2147/JMDH.S90822

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

This project was supported by Barretos Cancer Hospital internal research funds (PAIP).

Author information

Authors and Affiliations

  1. Oncology Post-Graduate Program (Stricto Sensu), Barretos Cancer Hospital, Barretos, São Paulo, Brazil

    Talita Caroline de Oliveira Valentino, Bianca Sakamoto Ribeiro Paiva & Carlos Eduardo Paiva

  2. Research Group on Palliative Care and Health-Related Quality of Life (GPQual), Barretos Cancer Hospital, Barretos, São Paulo, Brazil

    Talita Caroline de Oliveira Valentino, Bianca Sakamoto Ribeiro Paiva, Marco Antonio de Oliveira & Carlos Eduardo Paiva

  3. Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    David Hui

  4. Department of Clinical Oncology—Breast and Gynecology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil

    Carlos Eduardo Paiva

  5. Institute of Education and Research—Post-Graduation, Street Antenor Duarte Villela, 1331, Barretos, São Paulo, CEP 14784-400, Brazil

    Carlos Eduardo Paiva

Authors
  1. Talita Caroline de Oliveira Valentino
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  2. Bianca Sakamoto Ribeiro Paiva
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  3. Marco Antonio de Oliveira
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  4. David Hui
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  5. Carlos Eduardo Paiva
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Contributions

Conceived and designed the experiments: CEP, BSRP, and TCOV. Performed the experiments: TCOV, BSRP, and CEP. Analyzed the data: MAO and CEP. Wrote the paper: TCOV, BSRP, and CEP.

Corresponding author

Correspondence to Carlos Eduardo Paiva.

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The authors declare that they have no conflict of interest.

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de Oliveira Valentino, T.C., Paiva, B.S.R., de Oliveira, M.A. et al. Factors associated with palliative care referral among patients with advanced cancers: a retrospective analysis of a large Brazilian cohort. Support Care Cancer 26, 1933–1941 (2018). https://doi.org/10.1007/s00520-017-4031-y

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  • DOI: https://doi.org/10.1007/s00520-017-4031-y

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