Table 3 Palliative/Supportive Care in Cancer Patients

Sanders, et al. 2010.

109 patients with lung cancer

To characterize the prevalence and intensity of supportive care needs and interest in specific supportive care services among individuals with lung cancer

Cross-sectional survey

Participants reported the greatest need in the physical and daily living domain, followed by psychological needs, health system and informational needs, and patient care support needs. The most common unmet need was a lack of energy and tiredness (75%). Higher levels of supportive care needs were associated with worse physical functioning, greater symptom bother, lower satisfaction with health care, and

higher levels of intrusive thoughts about cancer.

Grudzen et al. 2010.

50 seriously ill adults with co- existing cancer in the emergency department

To identify the palliative care needs of seriously ill, older adults in the emergency department (ED).

Cross-sectional survey

Over half of the patients exceeded intratest severity-of- needs cutoffs in four categories of the Needs Near End of Life (NEST): physical symptoms (47 / 50, 94%),

finances (36 / 50, 72%), mental

health (31 / 50, 62%), and access

to care (29 / 50, 58%). The majority of patients reported moderate to severe fatigue, pain,

dyspnea, and depression on the ESAS.

Temel et al. 2010

151 patients with metastatic lung cancer

To examine the effect of early palliative care integrated with standard oncologic care on patient- reported outcomes, the use of health services, and the quality of end-of-life care among patients with metastatic

non-small-cell lung cancer.

Non-blinded, randomized, controlled trial

Patients assigned to early palliative care had a better quality of life than did patients assigned to standard care (mean score on the FACT-L scale, in which scores range from 0 to 136, with higher scores indicating better quality of life], 98.0 vs. 91.5; P = 0.03). In

addition, fewer patients in the palliative care group than in the standard care group had depressive symptoms (16% vs. 38%, P = 0.01). Despite the fact that fewer patients in the early palliative care group than in the standard care group received aggressive end-of-life care (33% vs. 54%, P = 0.05), median survival was longer among patients receiving early palliative care

(11.6 months vs. 8.9 months, P = 0.02).

Glare, et al. 2011.

119 patients in a GI oncology practice specializing in colorectal cancer and neuroendocrine tumors

To explore the implementation of the NCCN screening and referral criteria in an outpatient GI oncology practice.

Cross-sectional survey

Using the 24 items for NCCN referral criteria to screen for specialist palliative care provider, identified 7 to 17% of patients as having PC issues and 13% of patients who might benefit from specialist referral.

Glare, et al. 2013

194

gastrointestinal oncology patients

To evaluate the feasibility and impact of implementing the NCCN Guidelines referral criteria as a trigger for PC

consults

Cross-sectional survey

Using the NCCN guidelines as a referral trigger, patients had a significant increase in access to the PC service, and appeared to occur earlier in the course of the disease. Almost two-thirds (73%) of patients would meet the

criteria for a PC consult.

Hui et al. 2014

366 cancer patients with PC referral and quality of care indicators

To examine how the timing and setting of PC referral were associated with the quality of

end-of-life care

Retrospective study

Earlier PC referral was associated with fewer emergency room visits (39% vs 68%; P < .001), fewer hospitalizations

(48% vs 81%; P < .003), and fewer

hospital deaths (17% vs 31%; P=

.004) in the last 30 days of life. Similarly, outpatient PC referral was associated with fewer emergency room visits (48% vs 68%; P < .001), fewer hospital admissions (52% vs 86%; P < .001), fewer hospital deaths (18% vs 34%; P5.001), and fewer intensive care unit admissions (4% vs 14%; P5.001). In multivariate analysis, outpatient PC referral (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.28–0.66; P < .001)

was independently associated with less aggressive end-of-life care. Men (OR, 1.63; 95% CI, 1.06-

2.50; P5.03) and hematologic malignancies (OR, 2.57; 95% CI, 1.18–5.59; P5.02) were associated with more aggressive end-of-life

care.

Bakitas et al. 2015

207 patients with advanced cancer

To compare the effect of early versus delayed PC on quality of life (QOL), symptom impact, mood, 1- year survival, and

resource use.

Randomized controlled trial

Patient-reported outcomes and resource use were not statistically significant between early versus delayed referral to palliative care. However, the 1-year survival rates after enrollment was improved with those in the early group

(63%) compared to 48% in the

delayed group (difference, 15%; P

= .038). Relative rates of early to delayed decedents’ resource use were similar for hospital days, intensive care unit days, emergency room visits, chemotherapy in last 14 days, and

home death.

Rocque et al. 2015

203 patients with hematologic malignancies

To evaluate the implementation of triggered palliative care

consultation (TPCC) as part of standard care

Prospective, pre-post, sequential cohort study

Implementation of TPPC significantly improved patients’ prognostic awareness of their cancer from 65 to 94%, enhanced the communication between the patient, PC provider and was viewed favorably by 74% of the oncologists. TPCC had minimal impact on hospice utilization, cost of care, survival, patient reported symptoms, and patient satisfaction, likely because

of the limited nature of the intervention.

Hui et al. 2016

60 international experts on palliative care

To develop consensus on a list of criteria for referral of patients with advanced cancer at secondary or tertiary care hospitals to outpatient palliative care

Delphi method using a structured communication technique to establish a convergence of opinion.

Panelists reached consensus on 11 major and 36 minor criteria for referral to palliative care (11 major criteria: severe physical symptoms, severe emotional symptoms, request for hastened death, spiritual or existential crisis, assistance with decision making or care planning, patient request for referral, delirium, spinal cord compression, brain or leptomeningeal metastases, within 3 months of advanced cancer diagnosis for patients with median survival of 1 year or less, and progressive disease despite second-line therapy. Consensus was also reached on 36 minor

criteria for specialist palliative- care referral.

Adelson et al. 2017.

113 inpatients with solid tumors

To develop and test four standardized criteria for automatic PC consultation on the inpatient solid tumor service.

Prospective cohort study

Automatic PC consultation using a standardized criteria decreased the 30-day readmission rates from 35 to 18% (P = .04), hospice referral rates increased from 14 to 26% (P = .03), and receipt of chemotherapy post-discharge decreased from 44 to 18% (P =

.03). There was no significant change in LOS (P = .15) or use of

the ICU (P = .11) between the groups. Patients in the intervention group were more likely to be discharged to home

with any home-based services

Molin, et al.

840

To explore the use

Prospective

The PALLIA-10 questionnaire

2019

hospitalized

of the PALLIA-10

multicenter

score appeared to be a reliable

adult patients

questionnaire in

study

predictive factor to refer patients

in conventional

advanced cancer

to PC team intervention, and

medicine or in

patients

prognostic factor for patients

radiotherapy

scored 4–5 and > 5. In addition, the

departments

PALLIA-10 score appeared as a

reliable prognostic factor for

death at 6 months, independent

from the variation of other

severity criteria.

Brinkman-

535

To investigate the

Prospective,

No significant difference in

Stoppelenburg

hospitalized

association

observational

hospital costs between patients

et al. 2019

patients with

between

study

with PCT as compared to patients

incurable

palliative care team

without PCT consultation. Patients

cancer

(PCT) consultation

with PCT consult had a worse life

and the content and

expectancy, performance status

costs of hospital

and more often had no more

care

options for anti-tumor therapy.

Hospital length of stay, use of

most diagnostic procedures,

medication and other therapeutic

interventions were similar.

Hui et al.

200 patients

To examine the

Retrospective

Among the outpatient palliative

2020

with advanced

proportion of

study

care referral, the median overall

cancer

patients referred to

survival from was 14 (95%

the PC clinic who

confidence interval 9.2, 17.5)

met the

months. A majority (n = 170, 85%)

standardized

of patients met at least 1 major

criteria and its

criteria; specifically, 28, 30%,

timing for referral

20, and 8% met 1, 2, 3, and ≥ 4

to the MDACC

criteria, respectively. The most

Supportive Care

commonly met need-based

Outpatient Clinic

criteria were severe physical

symptoms (n = 140, 70%),

emotional symptoms (n = 36,

18%), decision-making needs (n =

26, 13%), and

brain/leptomeningeal metastases

(n = 25, 13%). For time-based

criteria, 54 (27%) were referred

within 3 months of diagnosis of

advanced cancer and 63 (32%)

after progression from ≥2 lines of

palliative systemic therapy. The

median duration from patient first

meeting any criterion to palliative

care referral was 2.4 (interquartile

range 0.1, 8.6) months

Caraceni, A. et

229 patients

To identify timing

Observational

Referral to Palliative care

al. (2020)

with thoracic

and factors

retrospective

Outpatient Clinic (POC) was

malignancies

associated to PC

study

significantly higher for patients

referral in patients

with worse performance status

with thoracic

(PS) (HR = 4.5), more advanced

malignancies, and

disease stage (HR = 3.1), pain

to describe their

(HR = 4.9), dyspnea (HR = 2.5) and

clinical care

cough

pathway.

(HR = 2.2). The multivariable model

confirmed independent

prognostic value for PS, disease

stage and pain. Results suggest

considering symptom burden, PS

and disease stage as screening

criteria for referral to PC in

patients with thoracic

malignancies.

Gemmel, R. et

159 patients

To identify the

Retrospective

Of the 159 patients identified, 46

al

who died

prevalence of

cohort study

% were referred to palliative care

(2020)

during hospital

cancer

prior to terminal admission.

admission, who

patients who died

Application of 6 out of 7 trigger

met criteria for

during a non-

tools would have resulted in the

palliative care

elective hospital

majority of patients (up to 91.2%)

consultation

admission, who met

referred to palliative care prior to

the criteria for a

admission. Most patients (52.2%)

palliative care

were referred only during their

consultation within

terminal admission. Patients

the 6 months prior

known to palliative care before

to death according

admission (N = 73) were reviewed

to a number of

quicker than those who were not

palliative care

(N = 86) (median (range)1 day (0–23

referral trigger

days) versus 5 days (0–59 days),

tools.

p < 0.00001).

Hansen, MB et

31,139 adult

To investigate if the

Retrospective

Clinically neglectable associations

al (2020)

cancer patients

symptomatology

review

were found between patients

registered in

(EORTC QLQ-C15-

referred by the general

the Danish

PAL questionnaire)

practitioner and hospital

Palliative Care

differed for patients

physician related to symptoms

database

referred to

(pain, appetite loss, fatigue),

specialized palliative

number of symptoms/problems,

care from general

number of severe symptoms/

practitioners in the

problems (odds ratios between

primary healthcare

1.05 and 1.20, all p < 0.05) and

sector and for

physical functioning (odds ratio=

patients referred by

0.81 (inpatient care) and 1.32

hospital physicians

(outpatient), both p < 0.05). The

in the secondary

survival time from referral to

healthcare sector.

specialized palliative care was on

average longer for patients

included in the study. The mean

number of symptoms/ problems were very similar for patients referred by the general practitioner and hospital physicians. The difference between patients referred by the general practitioner and the hospital physician did not seem to be clinically relevant for any of the symptoms/problems or overall QOL.