Earlier palliative care lowers costs, may extend survival for patients with advanced cancer

Early palliative care reduced costs among patients with advanced cancer, according to retrospective study results.

In addition, early palliative care appeared associated with better survival outcomes compared with standard oncologic care.

“These findings provide further evidence for policies arguing that earlier access to routine palliative care among [patients with advanced cancer} should become a health care priority,” Christopher K. Daugherty, MD, professor of medicine and director of supportive oncology in Pritzker School of Medicine at The University of Chicago, and colleagues wrote.

Palliative care has been shown to improve quality of life, transitions to end-of-life care and mortality. However, the financial implications, discharge disposition and survival benefits of early, inpatient palliative care remain less understood, according to study background.

Daugherty and colleagues sought to compare outcomes of early palliative care and standard oncologic care with or without a palliative care consultation among 810 patients with advanced cancer who received treatment between January and December 2015.

The results — presented at Palliative and Supportive Care in Oncology Symposium — showed patients who received immediate palliative care (n = 468) were more likely to be younger (61.1 years vs. 62.5 years; P = .02), black (48% vs. 36%; P = .0045), female (50% vs. 40%; P = .005) and have a shorter hospital stay (5.7 days vs. 6.2 days; P = .01) than those who received standard of care (n = 342).

Patients admitted to early palliative care had significantly lower costs, including direct ($9,478 vs. $10,416, P = 0.01), indirect ($9,538 vs. $10,999, P = 0.002), fixed ($10,308 vs. $12,076, P = 0.001), variable ($8,709 vs. $9,339, P = 0.02) and operating costs ($19,017 vs. $21,416, P = 0.003). These patients appeared more likely to be discharged to their homes (55% vs. 45%, P = 0.01), health care facilities (36.1% vs. 20%, P = 0.04) and hospice (7.7% vs. 5.8%, P = 0.02). They also achieved longer median survival from the time of hospital discharge.

HemOnc Today spoke with Daugherty about the study and the potential implications of the findings.

Question: What prompted this research?

Answer: There is an ever-increasing amount of data that show the ability of palliative care to ease symptom burden, improve quality of care and potentially reduce the costs of care. With this in mind, we implemented a clinical program to have patients with cancer seen within 24 hours by both the medical oncologist and palliative care physician.

Q: How did you conduct the study?

A: As patients were admitted to our hospital, they were assigned by either patient or physician preference to a supportive oncology service, where they received a joint palliative care consultation within 24 hours alongside care from a medical oncologist or regular oncology service. This was not a randomized controlled trial by any means, and patients were not matched by age, disease or sex. Patients were assigned based upon bed availability or preferences. At the end of 1 year, we pooled data to determine the differences in outcomes between the two groups.

Q: What did you find?

A: Those who received immediate palliative care consults had greater cost savings and appeared to have shorter hospital stays than those who did not receive immediate palliative care. Survival time as a whole also appeared better among those who received immediate palliative care. Another interesting finding was that the population admitted to immediate palliative care was more likely to be female and black — two demographics that we recognize as being underserved. It appears that differences on the part of the physician, patients or their families were driving the decisions about which services the patients were assigned to receive. There were more white males who chose general oncology services without our immediate palliative care consultation process. This may have to do with how palliative care is perceived by some people, which is that it is exclusively end-of-life care. Of course, as health care providers, we understand that there are a lot of data about the value of palliative care — it reduces costs, improves outcomes and extends survival — and we should all recognize that palliative care is not simply end-of-life care.

Q: What are the clinical implications of the findings?

A: We should continue to build and expand access to palliative care services for our patients earlier and more often. We also should target and personalize palliative care depending upon patients’ disease burdens.

Q: Do you have plans for additional research?

A: We have outpatient supportive care services and we are looking at the outcomes of these patients in the outpatient setting. We are interested in expanding palliative care in the broadest sense and we are looking at integrative oncology to bring in other disciplines, such as acupuncture, to see how this might further reduce symptom burden and lead to better patient outcomes. – by Jennifer Southall

Reference:

Daugherty C, et al. Abstract 130. Presented at: Palliative and Supportive Care in Oncology Symposium; Nov. 16-17, 2018; San Diego.

For more information:

Christopher K. Daugherty, MD, can be reached at The University of Chicago Medicine, 5841 S. Maryland Ave., Chicago, IL 60637; email: cdaugher@medicine.bsd.uchicago.edu.

Disclosure: Daugherty reports no relevant financial disclosures.