• rss
  • facebook
  • twitter
  • linkedin

Winning Abstracts from the 2011 Medical Student Abstract Competition: Effect of Palliative Care Services on End of Life Care in Cancer Patients

Author: Tracy Davies, Creighton University School of Medicine, Class of 2012

Introduction: End-of-life (EOL) cancer care affects a large number of Americans each year. Terminal cancer patients have been experiencing increasing use of overly aggressive anticancer treatments and disparities in access to hospice services. Hence, EOL care has become increasingly aggressive but is not associated with higher quality care or lower mortality rate. This raises concerns about the appropriateness of aggressive EOL care and the possibility of dedicated palliative care teams to help attenuate this phenomenon. Previously identified indicators of aggressive EOL care are: use of chemotherapy in last 30 days, low rates of hospice use and interventions resulting in ER visits, hospitalizations or ICU admissions. We compared the trends of aggressiveness of care amongst the Veteranís Affairs cancer population in our hospital and assessed the effects of palliative care (PC) services on EOL care.

Methods: We identified the last 100 cancer patients at our universityís Veteranís Hospital who died in 2008 and the last 100 cancer patients who died in 2002. Age, date of diagnosis, survival, date of palliative consult, hospice initiation, hospice duration, treatments received and location of patient in the last 30 days of life were recorded.

Results: Mean age was 72 years (range: 45-90). 170 (85%) patients had metastatic disease. In the last 30 days of life, cancer patients had more aggressive care in 2008 than 2002 in terms of 1) incidences of chemotherapy administered (18% vs. 10%, p = 0.04), 2) ICU admissions (33% vs. 6%, p < 0.001) 3) >14 days of hospital stay (38% vs. 6%, p < 0.001) and 4) hospital deaths (38% vs. 18%, p < 0.01). The palliative care (PC) service program was initiated in 2003. In 2008, in the last 30 days of life, patients with PC consults = 2 weeks before death had fewer ICU admissions (24% vs. 73%), ER visits (0% vs. 25%), and hospitalizations (8% vs. 40%) when compared to patients without or with late PC consults. Patients with timely PC consults also had more hospice consults (76% vs. 38%, p < 0.001), were less likely to die in the hospital (26% vs. 43%, p = 0.04) and less likely to spend = 3 days in hospice before death (29% vs. 55%, p = 0.004).

Conclusion: Over the last decade, EOL care has gotten more aggressive in the VA healthcare system. Nevertheless, timely PC services improve the quality of EOL care and should be considered in every patient with metastatic cancer regardless of treatment goals.

Back to October Issue of IMpact

More Articles Like This

Students: Join ACP for Free

Benefits of Membership for Students: ACP's free Medical Student Membership includes benefits designed especially to meet students' needs.

Join Now: Sign-up today and begin enjoying the benefits of ACP Medical Student Membership.

Find a Residency

Search ACP's Internal Medicine Residency Database for information on all internal medicine residency programs in the U.S. and Canada. (ACP Members only)

More search options

Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health, 2nd Edition

Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health, 2nd Edition This new edition reflects recent clinical and social changes and continues to present the important issues facing practitioners and their LGBT patients. Read more about the Guide. Also see ACP's recent policy position paper on LGBT health disparities.

Join Us in Washington, DC for the Most Comprehensive Meeting in Internal Medicine

Join Us in Washington, DC for the Most Comprehensive Meeting in Internal Medicine
Register now and enjoy:

Discounted rates, the best national faculty, a wealth of clinical and practice management topics and hands-on sessions! Learn more about the meeting.