Integrated Palliative care in Metastatic gastrointestinal Cancer: A Retrospective Experience from a Lead Cancer...

The goal of palliative care is to alleviate the suffering of patients with advanced cancer, such as through pain management. Multiple randomized controlled trials have supported the early integration of palliative care. Despite the undeniable advantages of early palliative care, most data have come from developed countries. This study offers real-life insights into the integration of palliative care services for patients with advanced gastrointestinal cancer and their impact on quality of life in a developing country.

We retrospectively evaluated patients with metastatic gastrointestinal cancer treated at our center from January 2018 to December 2022. The subjects included patients with metastatic gastrointestinal (GI) cancer who received palliative care either within 90 days of diagnosis (early group) or after 90 days (late group). The impact of early versus late integration of palliative care was assessed.

A total of 216 patients were included in the analysis - 123 in the early group and 93 in the late group. While the majority of patients were referred electively to palliative care, emergency referrals were more frequent in the early group (62 total; 40 [64%] in the early group, 22 [36%] in the late group, p = 0.15). The number of patients receiving chemotherapy in the last 30 days of life was 39 (early group: 17; late group: 22; p = 0.06). On the Edmonton Symptom Assessment Scale (ESAS), symptoms such as pain, nausea, and wellbeing were better controlled in the early group, although the differences were not statistically significant. The disease burden was significantly higher in the early group (p = 0.01).

Despite a higher disease burden in the early group, symptom control was comparable between the groups. The greater number of emergency referrals in the early group highlights the role of palliative care during crises and underscores the need for better integration of palliative care services.