Background: Support and involvement of palliative care is important for patients with advanced malignancy. Early referral improves patient’s symptom, quality of life and reduces the institution’s financial burden.
Aims: To review a single institution’s experience, rates of involvement of the inpatient palliative care team for oncology patients on palliative chemotherapy over six months.
Methods: Retrospective case note review of admissions from May to October 2019.
Results: Of the 173 patients admitted to the unit, 120 (69%) were on palliative chemotherapy. Primary sites were 28% lung, 19% breast, 16% colon, 8% melanoma and 5% pancreatic cancer. 20% had CNS metastasis. Admissions were: 59 (49%) disease complications, 38 (32%) treatment complications and 23 (19%) multifactorial causes. 32 patients (27%) transitioned to a supportive or palliative care focus and were reviewed within 24 hours upon referral. Of the 32 patients, eleven patients (34%) ceased systemic therapy and transitioned to outpatient palliative supportive care. Twenty-one patients (66%) went on to receive inpatient terminal care. 10 patients (48%) had treatment for reversible causes prior to the decision of terminal care, while 11 patients (52%) the decision for terminal care was made within 2 days due to a more rapid deterioration. Two thirds of terminal care patients (67%) died on a medical oncology ward awaiting a palliative bed while 7 patients (33%) were transferred to a dedicated palliative ward or private hospice. 70% of transitioned patients (23/32) had their first palliative care encounter during that admission.
Conclusion: 1 in 4 admitted patients (27%) transitioned to supportive or terminal care, majority of whom were not previously known to palliative care. 1 in 6 patients (17%) had a terminal admission, and two thirds of those died on the oncology ward. Future improvements should focus on early palliative care referral and availability of dedicated terminal care beds for inpatients.