Hypothesis The use of joint oncology and palliative care clinics (JOPCC) to introduce palliative care early in the disease trajectory will reduce the number and length of subsequent non-elective hospital admissions in patients with cancer.
Rationale Patients with cancer are often admitted to hospital to gain symptom control or for management of acute complications (Numico, Cristofano, Mozzicafreddo, Cursio et al., 2015). Previous research has shown the early intervention of palliative care can improve patient quality of life (Temel, Greer, Muzikansky, Gallagher et al., 2010) and reduce hospital admissions (Hui, Kim, Roquemore, Dev et al., 2014). For the past 20 years, Royal Cornwall Hospital Trust (RCHT) have aimed to achieve this by allowing the two specialties to run in parallel (Benham, Broadbent, Mader, Palmer et al., 2017).
Methods Data were collected from 54 patients seen in JOPCC and 59 patients seen in control standard oncology clinics (SOC) throughout 2016. Patients diagnosed with breast, prostate, upper and lower gastrointestinal cancers were included. Patients admitted electively (e.g. for planned chemotherapy or transfusion) were excluded. Patient electronic records were used to identify the number of non-elective hospital admissions, reason and length of admission.
Results In JOPCC there were 45 non-elective hospital admissions compared to 70 admissions in SOC. The main reason for admission in both groups was for new complications of diagnosis: JOPCC 84.4%; SOC 85.5%. Complications of treatment were more common in the SOC patients; JOPCC 10.5%; SOC 26.7%. The average length of admission was significantly shorter (p=0.0015) in the JOPCC (4.8 days).
Conclusions JOPCC appear to reduce both the number and length of non-elective admissions. This may be partly attributed to fewer patients actually receiving treatment or having previous access to palliative care teams; resulting in fewer admissions. Further research comparing non-elective admissions within 12 months from first consultation with a larger sample size, confining data to a single site-specific cancer diagnosis will allow further conclusions to be made.
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