Background It is well established that patients with advanced gastric and pancreatic carcinoma on second line chemotherapy have a poor prognosis. Studies have shown that early Specialist Palliative Care (SPC) input can improve symptom burden and quality of life. The aims of this project are to improve earlier access to SPC services, assess symptom for patients with advanced gastric and pancreatic cancer and to establish earlier Advance Care Planning (ACP) discussions with patients.
Method All patients who failed to respond to first line treatment and progressed to second line chemotherapy, with above cancers were selected for SPC consultations at the chemotherapy centre in a tertiary oncology centre. Data collected between September 2020 to September 2021. Audit cycles were repeated in February 2021 with implementations of ACP leaflets and they were all given follow-up consultations.
Results 14 patients were assessed in first cycle. 50% had symptoms and received medical interventions by SPC team. 93% of patients were discharged from SPC after first visit as 60% already known to community SPC team and 50% were asymptomatic. Only 43% patients were introduced to ACP, 7% had Preferred Place of Death (PPD) and 14% had Preferred Place of Care (PPC) discussions. 7 patients were seen in second cycle. With ACP leaflets’ implementation, this led to a significant improvement of PPD (56%) and PPC (86%) discussions. 86% of patients had symptoms and received medical interventions by SPC team, of which 33% already reported improved symptoms at first follow-up consultations.
Conclusion This project demonstrated that proactive SPC involvement can enable earlier ACP discussions and improve symptom burden. With the above interventions, this has led to an increase of ACP conversations. Results have shown that increased collaboration between upper gastrointestinal cancer and SPC services in the future would be beneficial for this group of patients.
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