Early Palliative Care Reduced ICU Use in Patients With Advanced Cancer

Palliative care initiated prior to hospitalizations in patients with advanced cancer can prove beneficial.
Palliative care initiated prior to hospitalizations in patients with advanced cancer can prove beneficial.

Early palliative care significantly reduced intensive care unit (ICU) and hospital admissions, reduced deaths in the hospital, and increased hospice enrollment in patients with advanced cancer at the end of life, a study published in The Oncologist has shown.1

Palliative care initiated early improves quality of life and survival in patients with advanced cancer; however, little is known about the impact of early palliative care on ICU use at the end of life.

To evaluate the effect of a comprehensive early palliative care program on ICU use and other outcomes in this population, investigators retrospectively analyzed data from 470 patients with advanced cancer, including 275 enrolled in an early palliative care program and 195 receiving standard care during the same period.

The multidisciplinary outpatient palliative care program comprised early end‐of‐life care planning, interdisciplinary meetings to discuss patient status each week, and patient‐reported outcomes evaluation integrated within the electronic health record.

Compared with patients who received early palliative care, results showed that patients who did not participate in the palliative care program had a 3-fold higher likelihood of being admitted to the ICU during the last 6 months of life (odds ratio [OR], 3.07) and more than a 4-fold increased likelihood of terminal ICU admission (OR, 4.69).

Patients in the control group also had a 4 times higher risk of death in the hospital (OR, 4.14), 5.5 times increased risk of death in the ICU (OR, 5.57), and nearly a 90% lower likelihood of hospice enrollment (OR, 0.13) compared with patients who participated in the early palliative care program.

However, investigators found no significant difference in the use of chemotherapy or radiotherapy, the length of ICU stay, code status, disposition location, outcomes after ICU admission, or ICU procedures (with the exception of cardiopulmonary resuscitation) between the 2 groups.

The findings underscore the benefit of palliative care initiated prior to hospitalizations or intensive care admission in patients with advanced cancer.

Reference

1. Romano AM, Gade KE, Nielsen G, et al. Early palliative care reduces end‐of‐life intensive care unit (ICU) use but not ICU course in patients with advanced cancer. Oncologist. 2017 Feb 18. dos: 10.1634/theoncologist.2016-0227 [Epub ahead of print]

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