2017 ASCO Annual Meeting!
Session: Patient and Survivor Care
Type: Poster Session
Time: Saturday June 3, 1:15 PM to 4:45 PM
Location: Hall A
Early specialist palliative care for all hospitalized, advanced cancer patients (ACP)? Better outcomes with “up-front” versus “on-demand” palliative care.
Patient and Survivor Care
2017 ASCO Annual Meeting
Poster Board Number:
Poster Session (Board #15)
J Clin Oncol 35, 2017 (suppl; abstr 10026)
Author(s): Monica Malec, Fay J. Hlubocky, Stacie K. Levine, Kristen Wroblewski, Bradford Lane, Ashley Thomas, William Dale, Christopher Daugherty; University of Chicago Pritzker School of Medicine, Chicago, IL; The University of Chicago Medicine, Chicago, IL; University of Chicago Medical Center, Chicago, IL; Department of Health Studies, University of Chicago, Chicago, IL; The Univeristy of Chicago Medicine, Chicago, IL; The University of Chicago, Chicago, IL
Background: Palliative care improves outcomes for cancer patients, especially those with advanced disease. Optimal timing for initiation of specialist palliative care remains undetermined. We created a Supportive Oncology inpatient service that integrates immediate “up-front” palliative care (IPC) consultation for selected ACP to supplement our usual oncologic care (UOC) service, which continued to utilize “on-demand” palliative care consultation. Here, we compare ACP populations and selected outcomes between these two versions of in-patient cancer care. Methods: A retrospective cohort analysis of ACP receiving either IPC or UOC between Jan 2015-Dec 2015 (N = 809). ACP were compared for age, gender, race, and ethnicity. Disease severity was determined by APR DRG weight, Risk of Mortality (ROM), and Severity score. Outcomes included examining differences between groups for: Length of stay (LOS), Cost, and 30 day readmission rate. Univariate and multivariate analysis were employed. Results: 468 ACP were admitted to IPC and 341 to UOC. Compared with UOC, ACP assigned to IPC were significantly younger (61.1±13.2 vs 63.3±13.0, p = 0.02); more likely female (50% vs 40%, P = 0.005); and more likely to be AA (47% vs 35%, P = 0.005). After adjusting for gender, age, race, and encounter type, ACP receiving IPC had higher ROM (52% v 47%, p = 0.03). There were no differences in APR DRG weight (p = 0.30) or Severity scores (p = 0.34). IPC had significantly lower costs ($12,050 vs $15,990, p = 0.003), less 30-day readmissions (16% vs 23%, p = 0.03), and a trend toward shorter LOS (5.6 ± 4.9 vs 6.2 ± 6.5, p = 0.10). Conclusions: Our data provides additional evidence for the benefits of earlier specialist palliative care consultation services, including patients traditionally identified as underserved.