Palliative Care Needs of Patients With Cancer Living in the Community

Sanford Institute of Public Policy, Duke University, Durham
Journal of Oncology Practice 11/2011; 7(6):382-8. DOI: 10.1200/JOP.2011.000455
Source: PubMed


With improved effectiveness of early detection and treatment, many patients with cancer are now living with advanced disease and associated symptoms. As cancer becomes a chronic illness, adequate attention to patients' symptoms and psychosocial needs in the community setting requires positioning of palliative care alongside cancer care. This article describes the current palliative care needs of a population of community-dwelling patients with advanced cancer who are not yet ready for transition to hospice.
This secondary analysis used quality-monitoring data collected in three community-based palliative care organizations. Analyses focused on people with cancer-related diagnoses who were receiving palliative care during 2008 to 2011.
The analytic data set included 4,980 people, 10% of whom had cancer. Median age was 71 years. Forty-eight percent had been hospitalized at least once in the 6 months before palliative care referral. Forty-nine percent had a Palliative Performance Score (PPS) of 40% to 60%; 40% had PPS ≤ 30%. Although 81% had an estimated prognosis of ≤ 6 months, 58% were expected to live weeks to months. Thirty-three percent had no identified healthcare surrogate; 59% had no do-not-resuscitate order despite declining functional status and limited prognosis. Ninety-five percent reported ≥ 1 symptom, and 67% reported ≥ 3 symptoms; a substantial proportion did not receive treatment for symptoms.
Patients referred to community-based palliative care experience multiple often-severe symptoms that have been insufficiently addressed. They tend to have declining performance status. Earlier palliative care intervention could improve outcomes but will require delivery models that better coordinate inpatient/outpatient oncology and community-based palliative care.

Download full-text


Available from: Dio Kavalieratos, Oct 09, 2015
22 Reads
  • Source
    Journal of Oncology Practice 11/2011; 7(6):346-8. DOI:10.1200/JOP.2011.000467
  • [Show abstract] [Hide abstract]
    ABSTRACT: CONTEXT: In the U.S., the number of hospital-based palliative care programs has increased rapidly, but availability of outpatient palliative care remains limited. Multiple barriers impede the financial viability of these programs. Four Seasons, a nonprofit organization in western North Carolina, delivers a full spectrum of palliative care in hospitals, nursing homes, assisted living facilities, patients' homes, and outpatient clinics; its catchment area encompasses approximately 350,000 people. Initially focused on hospice care, Four Seasons added its palliative care program in 2003. Before the inquiry described herein, financial losses from outpatient palliative care (2003-2008) were escalating. OBJECTIVES: We explored organizational and financial barriers to sustainability of palliative care, so as to 1) identify reasons for financial losses; 2) devise and implement solutions; and 3) develop a sustainable model for palliative care delivery across settings, including the outpatient setting. METHODS: In 2008, Four Seasons's palliative care program served 305 patients per day (average) with 10.5 providers (physicians, nurse practitioners, and physician assistants); financial losses approached $400,000 per year. We used Quality Assessment and Performance Improvement cycles to identify challenges to and inefficiencies in service provision, developed targeted strategies for overcoming identified barriers to cost-efficiency, instituted these measures, and tracked results. RESULTS: In 2011, Four Seasons served 620 palliative care patients per day (average) with 14 providers; financial losses decreased by 40%. CONCLUSION: With health care reform promoting integration of care across settings, outpatient palliative care will gain importance in the health care continuum. Process changes can help reduce financial losses that currently impede outpatient palliative care programs.
    Journal of pain and symptom management 07/2012; 44(6). DOI:10.1016/j.jpainsymman.2011.12.278 · 2.80 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Despite improvements in cancer therapies, cancer is the leading cause of death worldwide. Many patients experience severe, unnecessary symptoms during treatment as well as at the end of life. Often, patients receive 'aggressive' care at the end of life that is discordant with their preferences. Palliative care is an approach that focuses on communication and quality of life, including treatment of physical, psychosocial, and spiritual suffering. This approach is appropriate for patients with life-limiting cancer, throughout the course of their disease. A growing body of evidence supports the integration of palliative care into routine cancer care, owing to the benefits in symptom control, quality of life, patient satisfaction, and resource utilization. Palliative care can be delivered in inpatient, outpatient, and home-based settings. The specialty and associated infrastructure is expanding rapidly with support from the international medical community. The ideal model of how to incorporate palliative care providers into the care of patients with cancer is yet to be defined; future research is needed to develop delivery systems and improve access to palliative care services. Through collaboration between oncologists and palliative care teams, there is hope of improving the quality of care for patients with both curable and life-limiting cancers.
    Nature Reviews Clinical Oncology 12/2012; 10(2). DOI:10.1038/nrclinonc.2012.211 · 14.18 Impact Factor
Show more