Background There is growing evidence to support the benefits of early integrated palliative care (PC) for patients with advanced cancer. Within a tertiary referral cancer centre we started a new Integrated Symptom Control and PC service. The aim of this service is to proactively identify patients who would benefit from PC review and to offer earlier support. The aim of this study is to assess the feasibility and outcomes of this service.
Methods This pre-post design study was approved locally, and is part of a national programme to develop Integrated PC. Two tumour groups were selected due to their poor prognosis; renal cell cancer (RCC) and gynaecological cancer (GC). The study was conducted between October 2016 and September 2017. 316 patients (RCC 111/GC 205) were assessed as part of the new service. 286 of these patients (RCC 100/GC 186) were formally assessed for PC needs using the validated Integrated Palliative care Outcome Scale (IPOS). Descriptive statistical analysis was conducted.
Results 12 months after initiation of the new integrated service, the proportion of patients with GC and RCC reviewed by PC at diagnosis of incurable disease had increased from 26% and 16% to 80% and 93% respectively. 79% (RCC) and 72% (GC) had severe or overwhelming psychosocial needs. 18% (RCC) and 25% (GC) had severe or overwhelming physical needs.
47 patients had died at time of analysis (16 RCC and 31 GC). Median time from review to death was 134 days (range 20–318 days). This compares to a median time between PC referral and death in the baseline cohort of 98 days (GC) and 83.5 days (RCC).
Conclusions The Integrated service proactively identifies patients with PC needs earlier and has highlighted the high burden of psychosocial needs. This study will underpin service development and improvement to include proactive intervention.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.