Clarifying When to Start Palliative Care

Cancer patient palliative care criteria defined

(RxWiki News) Many people may be under the impression that palliative care is only end-of-life care. Not so. Palliative care is focused on quality of life, symptom relief and help with making decisions for anyone with a serious illness.

Findings from a pilot study have led to the development of standardized criteria that defines when to offer cancer patients palliative care consultations.

The study found that following these criteria resulted in more palliative care consultations, lower hospital readmission rates, greater use of hospice (end of life) care and improved quality of life for cancer patients.

"Find out about palliative care services for serious illness."

Kerin Adelson, MD, assistant professor of Medicine, Hematology and Medical Oncology at the Icahn School of Medicine at Mount Sinai Hospital, was the lead author of the initiative.

Palliative care is a medical specialty that’s designed to support seriously ill patients, their caregivers and physicians as they address ongoing symptoms such as pain, coordinate care and facilitate decision making.

"Palliative care is supportive whole person care and a model that should apply to care in general," Christina Puchalski, MD, MS, FACP, founder and director of the George Washington Institute for Spirituality and Health (GWish), told dailyRx News.

"People who have complex psychosocial and spiritual issues benefit from palliative care in both inpatient and outpatient settings," Dr. Puchalski explained.

“Oncologists often equate palliative care with end-of-life care; to many, calling in a palliative care specialist is an admission of defeat,” Dr. Adelson said in a statement. “However, failure to identify patients who could most benefit from palliative care often results in inadequate pain control, emotional distress for patients and caregivers, and overuse of aggressive medical interventions.”

In 2012, the American Society of Clinical Oncology offered a provisional clinical opinion calling for palliative care to be offered along with treatment to any cancer patient with metastatic (has spread) disease and/or high symptom burden at the time of diagnosis.

The Mount Sinai researchers developed criteria for when to order a palliative care consultation based on interviews with experts and an extensive literature review.

The criteria suggested that any patient with the following should be offered a palliative care consultation:

  • Stage IV solid tumor
  • Stage III pancreatic or lung cancer
  • Hospitalization within previous 30 days
  • Extended hospitalization (more than seven days)
  • Uncontrolled symptoms, including pain, nausea, shortness of breath, delirium and psychological distress

The research team compared two groups of Mount Sinai patients: 61 cancer patients in the pilot group who were admitted over a three-month period and 51 patients (pre-intervention group) who had been treated during a six-week period prior to the pilot study.

Compared to patients in the pre-intervention group, the pilot group saw the following:

  • A doubling of palliative care consultations, increasing from 41 percent to 82 percent.
  • Hospice use increased from 14 percent to 21 percent.
  • 30-day hospital readmission rates were lowered from 36 percent to 17 percent.
  • The mortality index among cancer patients fell from 1.39 to 0.59, meaning that fewer patients were dying in the hospital than would be expected based on the severity of their illness.
  • Hospital lengths of stay did not differ among the groups.

Dr. Puchalski said, "Palliative care should be included much earlier in the trajectory of cancer or other illnesses — from initial diagnosis, through survivorship, recurrence and advanced illness."

Dr. Adelson said that the pilot intervention has become the standard of care at Mount Sinai. “Widespread adoption of similar interventions could lead to national improvements in patient care for people with late-stage cancer.”

Findings from this study were presented at the ASCO 2013 Quality Care Symposium. The findings from this study should be considered preliminary until published in a peer-reviewed journal.

No conflicts of interest were reported.

Review Date: 
October 29, 2013