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Palliative care referral and associated outcomes among patients with cancer in the last 2 weeks of life
  1. Mathilde Ledoux1,
  2. Wadih Rhondali1,
  3. Véronique Lafumas1,
  4. Julien Berthiller2,
  5. Marion Teissere3,
  6. Céline Piegay2,
  7. Sandrine Couray-Targe3,
  8. Anne-Marie Schott3,
  9. Eduardo Bruera4 and
  10. Marilène Filbet1
    1. 1Département de Soins Palliatifs, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Lyon, France
    2. 2Département d'Information Médicale, Centre Hospitalier de Lyon-Sud, Hospices Civils de Lyon, Lyon, France
    3. 3Pôle Information Médicale Evaluation Recherche (IMER), Hospices Civils de Lyon, Lyon, France
    4. 4Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
    1. Correspondence to Professor Marilène Filbet, Département de Soins Palliatifs, Centre de soins palliatifs Pavillon 1K, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, 165, chemin du Grand-Revoyet, Pierre-Bénite cedex, Lyon 69495, France; marilene.filbet{at}gmail.com

    Abstract

    Background Palliative care (PC) improves the quality of life of patients with advanced cancer. Our aim was to describe PC referral among patients with advanced cancer, and associated outcomes in an academic medical centre.

    Methods We reviewed the medical records of 536 inpatients with cancer who had died in 2010. Our retrospective study compared patients who accessed PC services with those who did not. Statistical analysis was conducted using non-parametric tests due to non-normal distribution. We also conducted a multivariate analysis using a logistic regression model including age, gender, type of cancer and metastatic status.

    Results Out of 536 patients, 239 (45%) had PC referral. The most common cancer types were respiratory (22%) and gastrointestinal (19%). Patients with breast cancer (OR 23.76; CI 6.12 to 92.18) and gynaecological cancer (OR 7.64; CI 2.61 to 22.35) had greater PC access than patients with respiratory or haematological cancer. Patients referred to PC had significantly less chemotherapy in the last 2 weeks of life than non-referred patients, with 22 patients (9%) vs 59 (19%; p<0.001). PC-referred patients had significantly fewer admissions to intensive care units in the last month of life than non-referred patients, with 14 (6%) vs 58 (20%; p<0.001).

    Conclusions There was a large variation in access to PC according to the type of cancer. There is a need to improve collaboration between the PC service and the respiratory, cancer and haematology specialists. Further research will be required to determine the modality and the impact of this collaboration.

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    • Received 18 September 2014.
    • Revision received 13 July 2015.
    • Accepted 6 September 2015.
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