Hostname: page-component-77c89778f8-m42fx Total loading time: 0 Render date: 2024-07-20T20:58:02.490Z Has data issue: false hasContentIssue false
  • English
  • Français

Timing of palliative care access and outcomes of advanced cancer patients referred to an inpatient palliative care consultation team in Brazil

Published online by Cambridge University Press:  10 September 2018

Letícia Taniwaki ,
Pedro Luiz Serrano Usón Junior ,
Polianna Mara Rodrigues de Souza  and
Bernard Lobato Prado
Letícia Taniwaki*
Affiliation:
Oncology and Hematology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
Pedro Luiz Serrano Usón Junior
Affiliation:
Oncology and Hematology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
Polianna Mara Rodrigues de Souza
Affiliation:
Oncology and Hematology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
Bernard Lobato Prado
Affiliation:
Oncology and Hematology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
*
Author for Correspondence: Letícia Taniwaki, M.D., Hospital Israelita Albert Einstein, Centro de Oncologia e Hematologia, Av Albert Einstein 627, São Paulo, Brasil05652-900. E-mail: le_taniwaki@yahoo.com.br
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Little is known about the outcomes of cancer patients referred to palliative care (PC) teams in developing countries. Our aim was to examine the timing of PC access and outcomes of patients with advanced cancer referred to an inpatient PC consultation team in Brazil.

Method

Retrospective study of consecutive patients with advanced cancer admitted to a tertiary care general hospital (April 2015–December 2016) and referred for the first time to an inpatient PC consultation team. Patients’ demographics, clinical features, time from first consult to death or discharge, and outcomes on medication use, clinical interventions, and end-of-life preferences were retrieved. An analysis was performed before and after PC.

Result

One hundred eleven patients were included. Median age was 68; 72% had an Eastern Cooperative Oncology Group performance status ≥3. The median timing of PC access was 9 days (first interquartile = 3, third interquartile = 19). The use of analgesics (from 75% to 85%, p = 0.001) and opioids (from 50% to 73%, p < .001) increased. A lower proportion was receiving antibiotics (68% vs 48%, p < 0.001), thromboprophylaxis (44% vs 26%, p < 0.001), antihypertensives (28% vs 15%, p = 0.001), and antiemetic agents (64% vs 54%, p = 0.027). Chemotherapy use was lower (39–25%, p < 0.001). More patients had an end-of-life preference (39% to 25%, p < 0.001) and were not willing to receive intubation (32% vs 60%, p < 0.001), intensive care treatment (30% vs 55%, p < 0.001), cardiopulmonary resuscitation (35% vs 62%, p < 0.001), and artificial nutrition (22% vs 34%, p < 0.001).

Significance of results

Although PC referrals occurred exceedingly late during the cancer disease trajectory, positive changes were observed in medication profiles, clinical interventions use, and end-of-life preferences of patients with advanced cancer referred to a specialized inpatient PC consultation team in Brazil. Further efforts are needed to improve early palliative cancer care in developing countries.

Keywords

Palliative careQuality of lifeTreatment outcomes
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 4 , August 2019 , pp. 425 - 430
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Al-Saleh, K, Al-Awadi, A, Soliman, N.A, et al. (2017) Timing and outcome of referral to the first stand-alone palliative care center in the Eastern Mediterranean region, the Palliative Care Center of Kuwait. American Journal of Hospice & Palliative Care 34(4), 325–329.10.1177/1049909115625959Google Scholar
Altman, DG (1990) Practical statistics for medical research. London: Chapman and Hall/CRC.Google Scholar
American Society of Clinical Oncology (2018) ASCO Institute for Quality. Available from https://www.asco.org/practice-guidelines/quality-guidelines.Google Scholar
Baek, YJ, Shin, DW, Choi, JY, et al. (2011) Late referral to palliative care services in Korea. Journal of Pain and Symptom Management 41(4), 692–699.Google Scholar
Bakitas, M, Lyons, KD, Hegel, MT, et al. (2009) Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: The Project ENABLE II randomized controlled trial. Journal of the American Medical Association Oncology 302(7), 741–749.Google Scholar
Bauman, JRand Temel, JS (2014) The integration of early palliative care with oncology care: the time has come for a new tradition. Journal of the National Comprehensive Cancer Network 12(12), 1763–1771.Google Scholar
Cheng, WW, Willey, J, Palmer, JL, et al. (2005) Interval between palliative care referral and death among patients treated at a comprehensive cancer center. Journal of Palliative Medicine 8(5), 1025–1032.Google Scholar
Connor, SR and Bermedo, MCS (2014) The global atlas of palliative care at the end of life. Geneva, CH/London: Worldwide Hospice Palliative Care Alliance, World Health Organization.Google Scholar
Dahlin, C (2009) The 2009 National Consensus Project for Quality Palliative Care (NCP) Guidelines (400). Journal of Pain and Symptom Management 37(3), 485–486.Google Scholar
Dalal, S and Bruera, E (2017) End-of-life care matters: Palliative cancer care results in better care and lower costs. Oncologist 22(4), 361–368.Google Scholar
Davis, MP, Temel, JS, Balboni, T, et al. (2015) A review of the trials which examine early integration of outpatient and home palliative care for patients with serious illnesses. Annals of Palliative Medicine 4(3), 99–121.Google Scholar
Ferrell, BR, Temel, JS, Temin, S, et al. (2017) Integration of palliative care into standard oncology care: American Society of Clinical Oncology Clinical Practice Guideline Update. Journal of Clinical Oncology 35, 96–112.Google Scholar
Greer, JA, Tramontano, AC, McMahon, M, et al. (2016) Cost analysis of a randomized trial of early palliative care in patients with metastatic nonsmall-cell lung cancer. Journal of Palliative Medicine 19(8), 842–848.Google Scholar
Hannon, B, Zimmermann, C, Knaul, FM, et al. (2016) Provision of palliative care in low- and middle-income countries: Overcoming obstacles for effective treatment delivery. Journal of Clinical Oncology 34(1), 62–68.Google Scholar
Higginson, IJ and Evans, CJ (2010) What is the evidence that palliative care teams improve outcomes for cancer patients and their families? Cancer Journal 16(5), 423–435.Google Scholar
Hui, D and Bruera, E (2016). Integrating palliative care into the trajectory of cancer care. Nature Reviews Clinical Oncology 13(3), 159–171.Google Scholar
Hui, D, Elsayem, A, De La Cruz, M, et al. (2010) Availability and integration of palliative care at US cancer centers. Journal of the American Medical Association Oncology, 303(11), 1054–1061.Google Scholar
Hui, D, Kim, SH, Roquemore, J, et al. (2014) Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients. Cancer 120(11), 1743–1749.Google Scholar
Hui, D, Li, Z, Chisholm, GB, et al. (2015a) Changes in medication profile among patients with advanced cancer admitted to an acute palliative care unit. Supportive Care in Cancer 23(2), 42–432.Google Scholar
Hui, D, Park, M, Liu, D, et al. (2015b) Attitudes and beliefs toward supportive and palliative care referral among hematologic and solid tumor oncology specialists. Oncologist 20(11), 1326–1332.Google Scholar
IBM Corp (2016). IBM SPSS Statistics for Windows. Armonk, NY.Google Scholar
Instituto Nacional de Câncer (2018) Estimativa 2018. Available from http://www1.inca.gov.br/estimativa/2018.Google Scholar
Jordan, K, Aapro, M, Kaasa, S, et al. (2018) European Society for Medical Oncology (ESMO) position paper on supportive and palliative care. Annals of Oncology 29(1), 36–43.Google Scholar
Loke, S-S, Rau, K-M and Huang, C-F (2011) Impact of combined hospice care on terminal cancer patients. Journal of Palliative Medicine 14(6), 683–687.Google Scholar
Lu, C-Y, Shen, W-C, Kao, C-Y, et al. (2016) Impact of palliative care consultation service on terminally ill cancer patients: A 9-year observational cohort study in Taiwan. Medicine 95(10), e2981.Google Scholar
Lynch, T, Connor, S and Clark, D (2013a) Mapping levels of palliative care development: A global update. Journal of Pain and Symptom Management 45(6), 1094–1106.Google Scholar
Lynch, T, Connor, S and Clark, D (2013b) Mapping levels of palliative care development: A global update. Journal of Pain and Symptom Management 45, 1094–1106.Google Scholar
Mack, JW, Weeks, JC, Wright, AA, et al. (2010) End-of-life discussions, goal attainment, and distress at the end of life: Predictors and outcomes of receipt of care consistent with preferences. Journal of Clinical Oncology 28(7), 1203–1208.Google Scholar
Masman, AD, van Dijk, M, Tibboel, D, et al. (2015) Medication use during end-of-life care in a palliative care centre. International Journal of Clinical Pharmacy 37(5), 767–775.Google Scholar
National Quality Forum (2012) Cancer Endorsement Maintenance 2011. Available from: http://www.qualityforum.org/Projects/Cancer_Endorsement_Maintenance_2011.aspx.Google Scholar
Nitecki, R, Diver, EJ, Kamdar, MM, et al. (2018) Patterns of palliative care referral in ovarian cancer: A single institution 5year retrospective analysis. Gynecology Oncology 148(3), 521–526.Google Scholar
Prigerson, HG, Bao, Y, Shah, MA, et al. (2015). Chemotherapy use, performance status, and quality of life at the end of life. Journal of the American Medical association Oncology 1(6), 778–784.Google Scholar
Sepúlveda, C, Marlin, A, Yoshida, T, et al. (2002) Palliative Care: The World Health Organization's Global Perspective. Journal of Pain and Symptom Management 24(2), 91–96.Google Scholar
Tang, ST, Liu, TW, Chow, JM, et al. (2014) Associations between accurate prognostic understanding and end-of-life care preferences and its correlates among Taiwanese terminally ill cancer patients surveyed in 2011–2012. Psychooncology 23(7), 780–787.Google Scholar
Temel, JS, Greer, JA, Muzikansky, A, et al. (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. The New England Journal of Medicine 363(8), 733–742.Google Scholar
Triplett, DP, LeBrett, WG, Bryant, AK, et al. (2017) Effect of palliative care on aggressiveness of end-of-life care among patients with advanced cancer. Journal of Oncology Practice 13(9), e760–e769.Google Scholar
World Development Indicators (2016) The World Bank. Available from https://datacatalog.worldbank.org/dataset/gdp-ranking.Google Scholar
World Health Organization (2017) WHO Definition of Palliative Care. Geneva: WHO. Available from http://www.who.int/cancer/palliative/definition/en/. Last accessed February 24, 2018.Google Scholar
Wright, AA, Zhang, B, Keating, NL, et al. (2014) Associations between palliative chemotherapy and adult cancer patients end of life care and place of death: prospective cohort study. BMJ: British Medical Journal, 348, G1219.Google Scholar
Yang, GM, Neo, SH, Lim, SZ, et al. (2016) Effectiveness of hospital palliative care teams for cancer inpatients: A systematic review. Journal of Palliative Medicine 19(11), 1156–1165.Google Scholar
Zimmermann, C, Swami, N, Krzyzanowska, M, et al. (2014) Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet 383(9930), 1721–1730.Google Scholar
Supplementary material: File

Taniwaki et al. supplementary material

Appendix

Download Taniwaki et al. supplementary material(File)
File 42 KB