Collaboration is key to effective cancer palliation

Jul 11 2012

By Sarah Guy

Collaborative decision-making and frequent meetings between palliative care teams (PCTs) and oncology staff are the most critical factors for improving end-of-life (EOL) care, say French researchers.

Their study results showed that the weekly onco-palliative meetings (OPMs) held at their institution were the only factor significantly associated with decreasing the odds for EOL patients undergoing chemotherapy in the last 2 weeks before death, and dying in an acute care setting, rather than at home.

"This suggests that in addition to early clinical intervention by the PCT, the quality of collaboration and the structuring of discussion may be necessary for integrating palliative care into oncology," say Isabelle Colombet (Hôpital Cochin, Paris) and co-investigators.

With data for 521 deceased cancer patients, the team assessed the impact of oncologists' awareness of palliative care, the intervention of the PCT, and the effect of OPMs, on factors such as patients' location of death and their use of emergency resources at EOL.

Almost half (49%) of the cohort died in an acute care ward - of whom 42% were there after an unscheduled visit to the emergency room - and just 11% of patients died at home.

After adjustment for factors including gender, age, cancer site, and emergency room visits, OPM was the only significant factor associated with location of patient death, reducing the chance of dying in a hospital (but not hospice) setting by 70%.

Similarly, discussion of patients' cases at OPM reduced the odds for them receiving chemotherapy in the last 14 days of life by 50% compared with not being discussed, although this association showed only a trend toward significance.

These associations remained in a separate subanalysis of 300 patients followed by the PCT, report the researchers, who also found a trend toward a significant twofold increase in use of emergency services in the last month of life among patients with an Eastern Cooperative Oncology Group performance status of 3 or 4, rather than 1 or 2.

The PCT intervened earlier in the trajectory of care given to patients discussed at OPM. Indeed, median survival was 75 days among discussed patients versus 29 in undiscussed ones; a significant difference.

Such collaboration as Colombet and colleagues describe can be "easily organized" in the oncology setting, they say in BMJ Supportive and Palliative Care, suggesting that early engagement with a PCT is necessary but not sufficient.

"Support by the oncologic 'soil' is needed and leads to integrative medicine," they conclude.

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