Recommending early integration of palliative care - does it work?

Area of Science:

• Oncology
• Palliative Care
• Healthcare Management

Background:

• A comprehensive cancer center implemented early integration (EI) of palliative care (PC) in 2006.
• This involved adopting the WHO definition of PC into cancer care guidelines and establishing a PC consulting team (PCST).
• The study assessed the experience with this approach to identify shortcomings.

Purpose of the Study:

• To evaluate the effectiveness of early integration (EI) of palliative care (PC) in a comprehensive cancer center.
• To identify challenges and areas for improvement in the EI of PC.
• To determine if EI of PC led to earlier intervention and reduced symptom burden in cancer patients.

Main Methods:

• Retrospective systematic chart analysis over a 2-year period (May 2006-April 2008).
• Analysis of 862 patients treated during the study period.
• Assessment of symptom prevalence and surrogate measures for advanced disease at first PC contact.

Main Results:

• Many patients (40%) had reduced performance status (ECOG 3-4) and significant symptom burden (e.g., dyspnea 27%) at first PC consultation.
• After one year of EI implementation, the average number of symptoms identified decreased from seven to three (p < 0.001).
• Surrogate measures for advanced disease, such as frailty, decreased from 63% to 33% (p < 0.001).

Conclusions:

• Early integration (EI) of palliative care (PC) showed positive results, with reduced symptom burden and improved performance status observed after the initial implementation phase.
• The World Health Organization (WHO) definition of PC alone was insufficient to effectively trigger EI.
• The authors recommend developing disease-specific guidelines to institutionalize EI of PC, with guidelines for 19 malignancies developed and presented separately.