Early Palliative Care Referrals Better for Cancer Patients

Involving palliative care teams early in the disease process in the outpatient setting can significantly improve end-of-life care for cancer patients, a recent study found.

In a secondary analysis of palliative care patterns at the University of Texas MD Anderson Cancer Center in Houston, researchers found that outpatient referrals to palliative care 3 to 6 months before death were associated with fewer emergency room visits, hospital admissions, and hospital deaths compared with inpatient or late referrals. The findings are published in Cancer.

“Bottom line, this study highlights that patients will benefit if referred early and often to palliative care services,” said David Hui, MD, MSc, assistant professor in the department of palliative care at MD Anderson and the study’s lead author, in a commentary in the July/August issue of Cancer.

The study, which included 366 patients, found that patients who had an initial consultation with an outpatient palliative care team after diagnosis were less likely to need aggressive end-of-life care. For example, they had fewer visits to the emergency department and intensive care unit during the last month of life compared with inpatient or late palliative care referrals.

Outpatient palliative care teams also helped facilitate early end-of-life discussions and provide practical and emotional support to patients. For example, the teams often detected and managed patients’ pain and depression; connected them with psychological services; and helped them avoid emergency department visits.

While the benefits of palliative care have been well documented, there are barriers to implementing the service in practice. Patients often have misconceptions about its purpose while some physicians are uncomfortable discussing end-of-life issues. However, palliative care discussions should not be limited to end-of-life, said Hui.

“The truth is that the principles of palliative care can be applied to many patients throughout the disease trajectory to alleviate symptom distress, provide emotional support, and facilitate communication and decision-making concurrent with cancer treatments,” he said.

The study’s authors acknowledged the important role of inpatient palliative care teams in alleviating patients’ symptoms, reducing caregiver stress, and assisting with transitions of care. However, their impact is limited because they typically care for patients only during the last month of life.

Outpatient teams, on the other hand, can play a significant role in improving overall quality of care throughout the disease process, the authors said. However, availability is an issue, since only 59% of National Cancer Institute (NCI)-designated cancer centers and 22% of non-NCI centers offer the service on an outpatient basis.

“To increase patient referral, multiple directions need to be taken,” said Hui, “including the devotion of more resources to palliative care programs, education of clinicians, public education, and advocacy, as well as more research to develop referral criteria.”