Screening Increases Early Palliative Care, Reduces Aggressive EOL Measures

Many women do not receive early palliative care before to succoming to their gynecologic malignancy.
Many women do not receive early palliative care before to succoming to their gynecologic malignancy.

Universal screening of women with gynecologic malignancies for early palliative care decreased the use of aggressive measures at the end of life (ACE), according to a study presented at the 48th Annual Meeting of the Society of Gynecologic Oncology.1

Early palliative care is associated with improved quality and duration of life, yet many women do not receive this care prior to dying of their gynecologic malignancy. The aim of this study was to determine the feasibility of increasing early access to palliative care by screening all women with high-risk gynecologic malignancies.

The single-center, prospective study enrolled 96 patients with high-risk disease, as defined by a 5-year prognosis of less than 30%. ACE score was determined for all patients who died, which assigned 1 point for aggressive measures that occurred within 30 days of death, including: fewer than 3 days of hospice, death in the intensive care unit/intubated, chemotherapy within 14 days of death, new chemotherapy, hospitalized fewer than 14 days, more than 1 hospital admission, more than 1 emergency department admission, and intensive care unit admission.

Screening significantly improved the palliative consultation rate to 68% compared with the center's historical rate of 49% (P =.014). Among the cohort, 25% had enrolled in hospice and 29% had died.

Higher ACE scores, which indicated more aggressive measures used at the end of life, was significantly higher in women who did not receive early palliative care (median 2.5) compared with women who did receive early palliative care (median 0; P <.05).

According to the investigators, the results of this study suggest that “universal screening rather than consultation-based referral was associated with increased access to palliative care.”

Reference

1. Nevadunsky NS, Zanartu C, Pinto P, et al. Early palliative care is associated with improved quality of end-of-life care for women with high risk gynecologic malignancies. Presented at: 48th Annual Meeting of the Society of Gynecologic Oncology; March 12-15, 2017; National Harbor, MD.

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