Patients who receive early palliative care use less health care, more support services

Patients hospitalized with advanced-stage cancers who received early palliative care showed decreased use of health care and increased use of support services, according to results of a prospective cohort study.

“As cancer progresses, patients are often at high risk for physical pain and emotional distress,” Cardinale B. Smith, MD, MSCR, associate professor at the Icahn School of Medicine at Mount Sinai, said in a press release accompanying the study. “Health care utilization is extremely high once cancer progresses, with hospital readmission rates as high as 40 percent and death in the acute care setting ranging from 30 to 50 percent — both measures of poor-quality cancer care.”

The researchers evaluated the outcomes of automatic palliative care consultations from August 2012 to January 2013. Based on standardized criteria they developed, the researchers referred patients to palliative care either before the intervention began (n = 48) or during the intervention period (n = 65).

Patients who met one or more criteria — advanced solid tumor, prior hospitalization within 30 days, hospitalization longer than 7 days or active symptoms — automatically received palliative care consultation.

Patients in the intervention group participated in palliative care consultation (80% vs. 39%; P < .0001) and hospice referrals (26% vs. 14%; P = .03) more frequently than those in the pre-intervention group.

Receipt of chemotherapy decreased after discharge (44% vs. 18%; P = .03) as did 30-day re-admission rates (35% vs. 18%; P = .04). Patients made increased use of support measures after being discharged from the hospital (P = .004). Researchers reported no change in length of stay.

“Our results highlight the need to adopt this practice at acute care hospitals across the nation,” Smith said in the press release. “Palliative care involvement helps patients understand their prognosis, establish goals of care and formulate discharge plans in line with those goals, and this study is the first to confirm the impact of using standardized criteria and automatic palliative care consultation on quality of cancer care.” – by Andy Polhamus

Disclosures: Smith reports honoraria from Teva. Please see the full study for a list of all other researchers’ relevant financial disclosures.