First referral to an integrated onco-palliative care program: a retrospective analysis of its timing

Autor: Camille Tlemsani, Olivier Huillard, Pascale Vinant, François Goldwasser, Vincent Montheil, Jérôme Alexandre, Claire Barth, Pascaline Boudou-Rouquette, Isabelle Colombet
Přispěvatelé: Université Paris Descartes - Paris 5 (UPD5), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Cancérologie Médicale [AP-HP Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Palliative Medicine [Paris]
Rok vydání: 2020
Předmět:
Male
Pediatrics
medicine.medical_specialty
Time Factors
Palliative care
Referral
lcsh:Special situations and conditions
[SDV.CAN]Life Sciences [q-bio]/Cancer
Disease
Advanced Cancer
03 medical and health sciences
Prostate cancer
0302 clinical medicine
Neoplasms
Oncology Service
Hospital
medicine
Humans
030212 general & internal medicine
Lung cancer
Referral and Consultation
Shared decision making
Aged
Retrospective Studies
Terminal Care
Performance status
Delivery of Health Care
Integrated
business.industry
lcsh:RC952-1245
Integration of oncology and palliative care
Cancer
General Medicine
Middle Aged
medicine.disease
[SDV.ETH]Life Sciences [q-bio]/Ethics
3. Good health
End-of-life care
030220 oncology & carcinogenesis
Female
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
business
Decision Making
Shared
Research Article
Zdroj: BMC Palliative Care, Vol 19, Iss 1, Pp 1-11 (2020)
BMC Palliative Care
BMC Palliative Care, BioMed Central, 2020, 19 (1), ⟨10.1186/s12904-020-0539-x⟩
ISSN: 1472-684X
DOI: 10.1186/s12904-020-0539-x
Popis: Background Palliative care (PC) referral is recommended early in the course of advanced cancer. This study aims to describe, in an integrated onco-palliative care program (IOPC), patient’s profile when first referred to this program, timing of this referral and its impact on the trajectory of care at end-of-life. Methods The IOPC combined the weekly onco-palliative meeting (OPM) dedicated to patients with incurable cancer, and/or the clinical evaluation by the PC team. Oncologists can refer to the multidisciplinary board of the OPM the patients for whom goals and organization of care need to be discussed. We analyzed all patients first referred at OPM in 2011–2013. We defined the index of precocity (IP), as the ratio of the time from first referral to death by the time from diagnosis of incurability to death, ranging from 0 (late referral) to 1 (early referral). Results Of the 416 patients included, 57% presented with lung, urothelial cancers, or sarcoma. At first referral to IOPC, 76% were receiving antitumoral treatment, 63% were outpatients, 56% had a performance status ≤2 and 46% had a serum albumin level > 35 g/l. The median [1st-3rd quartile] IP was 0.39 [0.16–0.72], ranging between 0.53 [0.20–0.79] (earliest referral, i.e. close to diagnosis of incurability, for lung cancer) to 0.16 [0.07–0.56] (latest referral, i.e. close to death relatively to length of metastatic disease, for prostate cancer). Among 367 decedents, 42 (13%) received antitumoral treatment within 14 days before death, and 157 (43%) died in PC units. Conclusions The IOPC is an effective organization to enable early integration of PC and decrease aggressiveness of care near the end-of life. The IP is a useful tool to model the timing of referral to IOPC, while taking into account each cancer types and therapeutic advances.
Databáze: OpenAIRE
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