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Palliative care benefited patients with advanced pancreatic cancer
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Patients with advanced pancreatic cancer who received palliative care underwent less aggressive end-of-life treatment, required fewer hospital admissions and survived longer than those who did not receive palliative care, according to study results.
Survival outcomes for patients with pancreatic cancer are traditionally poor. Because the disease often is diagnosed at an advanced stage, only 20% of patients are eligible for surgery. Even among these patients, 5-year survival is about 20%, according to study background.
Consequently, quality of life and care tend to become primary concerns for patients with advanced pancreatic cancer. Prior research showed aggressive care has been linked to worse quality of life, as well as a more difficult bereavement adjustment for family and caregivers.
Raymond W. Jang, MD, of the division of medical oncology and hematology at Princess Margaret Cancer Center in Toronto, and colleagues conducted a retrospective, population-based study to evaluate the effect of palliative care on the aggressiveness of near-death care in patients with advanced pancreatic cancer.
The researchers assessed the impact of palliative care on four care metrics: receipt of chemotherapy within 14 days of death, and repeat visits to hospital EDs, admission to the ICU and multiple hospitalizations within 30 days of death.
They also assessed the effect of the intensity of palliative care on the same measures of aggressive care. Intensity was defined as the total number of palliative care visits before the outcome and a monthly rate of visits.
The study included 5,381 patients diagnosed with advanced pancreatic cancer in Ontario, Canada, between 2005 and 2010. All patients died prior to the final follow-up in March 2011.
Patients aged ≥80 years comprised 29.1% of the population. There were an equal number of men and women.
Slightly more than half (52.3%) of patients in the cohort had a palliative care consultation; 9.5% had one visit, 10.3% had two visits, and 32.5% had three or more visits.
Patients who received palliative care were less likely to undergo chemotherapy within 14 days of death (2.6% vs. 5.6%; OR=0.34; 95% CI, 0.25-0.46).
They also were less likely to be admitted to the ICU (1.1% vs. 7.8%; OR=0.12; 95% CI, 0.08-0.18) or require multiple hospitalizations (3.8% vs. 12.8%; OR=0.24; 95% CI, 0.19-0.31) within 30 days of death.
Patients who received palliative care were nearly four times less likely than those in the non-palliative care group to visit the ED multiple times within 30 days of death (7.4% vs. 28.5%; OR=0.19; 95% CI, 0.16-0.23).
Patients who received palliative care also demonstrated longer median survival (100 days vs. 51 days) than those who did not receive palliative care.
“Our work provides an effectiveness analysis of palliative care in routine clinical practice that clinical trials cannot provide,” Jang and colleagues wrote. “Given the evidence that aggressive care has been associated with worse quality of life for patients and their families, is often incongruent with patient wishes and is increasing over time, it is our hope that our study will add an important piece to the growing literature on the benefits of palliative care and provide an impetus to increase the availability of palliative care worldwide.”
Disclosure: The researchers report no relevant financial disclosures.
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