Non-Cancer Palliative Care Use Growing

By Marilynn Larkin

December 12, 2019

NEW YORK (Reuters Health) - Inpatient palliative care teams in the U.S. are caring for more patients with diagnoses other than cancer, starting care earlier in the disease course, and sending more patients home, a study reveals.

"Our hope was that our analysis would provide a 'State of the Union' of sorts for the field of palliative care, and what we found was mostly reassuring," Dr. Laura Schoenherr of the University of California, San Francisco told Reuters Health by email.

"Given that studies continue to demonstrate the benefits of early palliative care for patients with all types of serious illness, we were encouraged to find that more patients are now able to experience the full benefits of this type of care," she said.

"Our study also highlights areas where palliative care teams are highly effective, such as in quickly relieving distressing symptoms like pain and shortness of breath, as well as important areas for ongoing improvement," she noted.

"For example, we found that only one-quarter of patients were seen by clinicians from at least three disciplines, such as nursing, social work, medicine, and/or chaplains, despite national guidelines recommending interdisciplinary care to ensure that all the issues important to people with serious illness are addressed."

The study included more than 135,000 patients at 88 hospitals participating in the Palliative Care Quality Network from 2013 through 2017.

As reported online in JAMA Network Open, about half of the patients were women, the mean age was 71.3, and all were significantly debilitated, with a mean Palliative Performance Scale score of 34.7%. Patients were referred for a palliative care consultation mainly for advance care planning (73.5%).

The most common primary diagnosis was cancer (32%), although rates decreased from 2013 to 2017 (odds ratio, 0.84). Other primary diagnoses included cardiac or vascular causes (13.2%), pulmonary (11.3%), neurologic or stroke (9.7%), and complex chronic conditions or failure to thrive (8.6%).

Pain, anxiety, nausea and dyspnea were common symptoms, and all improved significantly during the palliative care consultation period, defined as the full course of palliative care that a patient receives during a single hospitalization.

Most patients (78.7%) were discharged home, and this rate increased over time (OR, 1.36).

Compared with 2013, rates of discharge referral to clinic-based (OR, 4.00) and home-based (OR, 2.63) palliative care also increased significantly by 2017, whereas referrals to hospice decreased (OR, 0.56).

Dr. Alexia Torke, Regenstrief Institute research scientist and Associate Chief of the Division of Internal Medicine and Geriatrics at Indiana University School of Medicine, told Reuters Health the findings align with what she and her colleagues see in their practices. "Our field has expanded to include more patients with neurologic, cardiovascular and other conditions as well as cancer," she said by email. "Also, we realize that early palliative care can have benefits because patients have symptoms such as pain and distress at many points during a serious illness."

"The study also found that more patients are receiving either home-based or outpatient palliative care after they are discharged from the hospital," she noted. "This may be both because the patients are seen earlier in their disease process and because outpatient and home palliative care programs are growing. This provides great opportunities to help patients with symptoms and advance care planning earlier in the illness."

"We need to continue to educate clinicians about palliative care and the benefits it can provide, so patients can receive these early referrals," she added. "There are still many missed opportunities to help patients through palliative care."

SOURCE: JAMA Network Open, online December 6, 2019.