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NEW YORK – In many cases, consultation about the availability of palliative care doesn’t occur until an advanced cancer patient has been hospitalized for a week.
A recent study sought to determine how quality of life and survival would be affected if a palliative care consultation was instead initiated in the emergency department before admission, thereby circumventing intensive end-of-life care.
The report, published recently in JAMA Oncology, found that the ED consultation led to improved quality of life with no statistically significant effect on survival rates.
For the study, a New York University-led study team conducted a randomized clinical trial to compare quality of life, depression, healthcare utilization, and survival in ED patients with advanced cancer randomly assigned to an intervention with an ED-initiated palliative care consultation as opposed to usual care.
Of the 136 participants, 69 patients were in the palliative care consultation intervention and 67 in usual care, where they might also may have received a palliative care consultation if it was requested by the admitting team or an oncologist. Among the 69 patients in the intervention, 41 died by the end of a year, as did 44 of the 67 patients who received usual care.
Results indicate that the ED palliative care intervention was associated with increased quality-of-life scores from study enrollment to week 12 – an average increase of 5.91 points in the intervention vs. an increase of 1.08 in the usual care group.
In addition, median survival was longer for patients in the intervention at 289 days, compared with the usual care group, 132 days, although the difference was not statistically significant because of the extremely variable length of survival in the study group.
No statistically significant differences were found for depression, admission to the intensive care unit, and discharge to hospice. The effect of palliative care on healthcare utilization, meanwhile, was "more nuanced" in the study, according to the authors.
"Emergency department-initiated palliative care consultation improved QOL [quality of life] in patients with advanced cancer and does not seem to shorten survival; the impact on healthcare utilization and depression is less clear and warrants further study," the study concludes.
In a related commentary, Eduardo Bruera, MD, of the University of Texas MD Anderson Cancer Center in Houston, asks, “Where do we go from here?”
Bruera answers, “It is important to define and test criteria for palliative care referral from the ED in daily clinical practices. ... It will also be important to understand the attitudes and adherence of patients when referred to outpatient palliative care from the ED. In view of the findings of this study, this research is much needed and justified.”