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The value of embedding: integrated palliative care for patients with metastatic breast cancer

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Abstract

Purpose

The American Society of Clinical Oncology recommends concurrent palliative care (PC) for patients with metastatic cancer. Recent data show benefits of early PC (at least 90 days before death). However, little is known about PC among patients who die from metastatic breast cancer.

Methods

Patients with metastatic breast cancer at a comprehensive cancer center. Analysis of medical records and clinician and patient surveys. Assess referral patterns and value to patients at the end of life (EOL) of a specialty PC service embedded in a breast oncology program; compare to a prior period of stand-alone PC.

Results

In the 18-month study period, oncologists referred for palliative care 105 of their 515 (20.4%) patients; 59 (11.5%) patients were seen by the PC physician. Of the 38 referred patients who died, 23 (60.5%) were seen by embedded PC and all 23 received PC within 90 days of death; 0 of 18 decedents with data available for analysis had ICU stays within 30 days of death. In an earlier 24-month period of stand-alone PC, 43 patients died after receiving PC, but only 11 (25.5%) received PC within 90 days of death (p < 0.01) and 7 of 43 had ICU stays within 30 days of death (p = 0.074).

Conclusions

Embedded PC was well-received by patients and oncologists, increased early PC referrals, and improved EOL care. Avoidable, unnecessary health care utilization at the end of life, such as ICU stays in the last month of life, represent an important potential reduction in patient suffering and system costs.

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Funding

The ABC clinic is partially supported by a Grant from the UCSF Give Breast Cancer the Boot Fund. The research evaluation itself received no funding.

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Authors and Affiliations

  1. Division of General Internal Medicine, Department of Medicine, University of California, 1545 Divisadero St, #313, San Francisco, CA, 94143-032, USA

    M. Rabow

  2. The ABC Clinic, University of California, San Francisco, CA, USA

    R. Small

  3. Princeton University, Princeton, NJ, 08544, USA

    A. Jow

  4. Division of Hematology and Oncology, Department of Medicine, University of California, San Francisco, CA, USA

    M. Majure, A. Chien, M. Melisko & H. Rugo

  5. Institute for Health Policy Studies, University of California, San Francisco, CA, USA

    J. Belkora

  6. Departments of Surgery and Radiology, University of California, San Francisco, CA, USA

    L. J. Esserman

Authors
  1. M. Rabow
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  2. R. Small
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  3. A. Jow
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  4. M. Majure
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  5. A. Chien
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  6. M. Melisko
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  7. J. Belkora
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  8. L. J. Esserman
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  9. H. Rugo
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Corresponding author

Correspondence to M. Rabow.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Rabow, M., Small, R., Jow, A. et al. The value of embedding: integrated palliative care for patients with metastatic breast cancer. Breast Cancer Res Treat 167, 703–708 (2018). https://doi.org/10.1007/s10549-017-4556-2

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  • DOI: https://doi.org/10.1007/s10549-017-4556-2

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