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Integrated palliative medicine in public oncology: a 10-year review
  1. Sik Kwan Chan1,
  2. Tai Chung Lam1,
  3. Horace Cheuk-Wai Choi1,
  4. Ka Chun Tsang1,
  5. Kwok-Keung Yuen2,
  6. Inda Soong3,
  7. Kam Hung Wong4,
  8. Louisa Lui5,
  9. Sing Hung Lo6,
  10. Macy Tong7,
  11. Raymond Lo8,9,
  12. Po Tin Lam10,
  13. Wai Man Lam11 and
  14. Bryan Li12
  1. 1Department of Clinical Oncology, University of Hong Kong, Hong Kong, Hong Kong
  2. 2Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, Hong Kong
  3. 3Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong
  4. 4Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, Hong Kong
  5. 5Department of Oncology, Princess Margaret Hospital, Hong Kong, Hong Kong
  6. 6Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, Hong Kong
  7. 7Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, Hong Kong
  8. 8Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
  9. 9Palliative Medicine, The Bradbury Hospice, Hong Kong, Hong Kong
  10. 10United Christian Hospital, Hong Kong, Hong Kong
  11. 11Haven of Hope Hospital, Kowloon, Hong Kong
  12. 12Palliative Medicine, Grantham Hospital, Hong Kong, Hong Kong
  1. Correspondence to Dr Tai Chung Lam, University of Hong Kong, Hong Kong, Hong Kong; lamtc03{at}hku.hk

Abstract

Objectives The rapid ageing population of Hong Kong has a high demand on oncology and palliative care (PC) service. This study was the first territory-wide assessment in Hong Kong to assess the palliative service coverage in patients with advanced cancer in the past decade.

Methods Cancer deaths of all 43 public hospitals of Hong Kong were screened. Randomly selected 2800 cancer deaths formed a representative cohort in all seven service clusters of Hospital Authority at 4 time points (2006, 2009, 2012, 2015). Individual patient records were thoroughly reviewed. Predictors of PC coverage was evaluated in univariable and multivariable analyses.

Results From 2006 to 2015, PC coverage improved steadily from 55.4% to 68.9% (p<0.001). Median time of referral to PC service to death was 25 days (IQR: 53). For duration of inpatient PC, the median time was 22 days (IQR: 44) and it was stable over the past 10 years. Median time of referral to outpatient service to death was 74 days (IQR: 144) and there was an improvement observed (p<0.05). The current system was highly heterogeneous that PC varied between 9.8% and 84.8% in different hospitals depending on the PC service infrastructure. Multivariable Cox model identified patients associated with lower PC coverage: male, <50, rapid disease deterioration and staying in hospitals without multidisciplinary team clinic and designated palliative bed support (all p<0.01).

Conclusion There was concrete achievement in palliative service development in the past decade. Heterogeneity and late service provision should be addressed in future.

  • cancer
  • end of life care
  • hospice care

Data availability statement

No data are available. Not available since national legislation and the terms of study ethics approval do not allow dataset sharing outside of the institutions participating in the analysis.

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Data availability statement

No data are available. Not available since national legislation and the terms of study ethics approval do not allow dataset sharing outside of the institutions participating in the analysis.

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Footnotes

  • SKC and TCL contributed equally.

  • Contributors SKC, TCL designed study concepts. SKC, TCL, HC-WC developed methodology. All authors performed data acquisition. SKC, TCL, HC-WC performed data analysis and interpretation. Authors drafted the work or revised it critically for important intellectual content; approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This study was supported by all seven service clusters of Hospital Authority.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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