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First referral to an integrated onco-palliative care program: a retrospective analysis of its timing

BACKGROUND: Palliative care (PC) referral is recommended early in the course of advanced cancer. This study aims to describe, in an integrated onco-palliative care program (IOPC), patient’s profile when first referred to this program, timing of this referral and its impact on the trajectory of care...

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Autores principales: Barth, Claire, Colombet, Isabelle, Montheil, Vincent, Huillard, Olivier, Boudou-Rouquette, Pascaline, Tlemsani, Camille, Alexandre, Jérôme, Goldwasser, François, Vinant, Pascale
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069048/
https://www.ncbi.nlm.nih.gov/pubmed/32164672
http://dx.doi.org/10.1186/s12904-020-0539-x
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author Barth, Claire
Colombet, Isabelle
Montheil, Vincent
Huillard, Olivier
Boudou-Rouquette, Pascaline
Tlemsani, Camille
Alexandre, Jérôme
Goldwasser, François
Vinant, Pascale
author_facet Barth, Claire
Colombet, Isabelle
Montheil, Vincent
Huillard, Olivier
Boudou-Rouquette, Pascaline
Tlemsani, Camille
Alexandre, Jérôme
Goldwasser, François
Vinant, Pascale
author_sort Barth, Claire
collection PubMed
description BACKGROUND: Palliative care (PC) referral is recommended early in the course of advanced cancer. This study aims to describe, in an integrated onco-palliative care program (IOPC), patient’s profile when first referred to this program, timing of this referral and its impact on the trajectory of care at end-of-life. METHODS: The IOPC combined the weekly onco-palliative meeting (OPM) dedicated to patients with incurable cancer, and/or the clinical evaluation by the PC team. Oncologists can refer to the multidisciplinary board of the OPM the patients for whom goals and organization of care need to be discussed. We analyzed all patients first referred at OPM in 2011–2013. We defined the index of precocity (IP), as the ratio of the time from first referral to death by the time from diagnosis of incurability to death, ranging from 0 (late referral) to 1 (early referral). RESULTS: Of the 416 patients included, 57% presented with lung, urothelial cancers, or sarcoma. At first referral to IOPC, 76% were receiving antitumoral treatment, 63% were outpatients, 56% had a performance status ≤2 and 46% had a serum albumin level > 35 g/l. The median [1st-3rd quartile] IP was 0.39 [0.16–0.72], ranging between 0.53 [0.20–0.79] (earliest referral, i.e. close to diagnosis of incurability, for lung cancer) to 0.16 [0.07–0.56] (latest referral, i.e. close to death relatively to length of metastatic disease, for prostate cancer). Among 367 decedents, 42 (13%) received antitumoral treatment within 14 days before death, and 157 (43%) died in PC units. CONCLUSIONS: The IOPC is an effective organization to enable early integration of PC and decrease aggressiveness of care near the end-of life. The IP is a useful tool to model the timing of referral to IOPC, while taking into account each cancer types and therapeutic advances.
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spelling pubmed-70690482020-03-18 First referral to an integrated onco-palliative care program: a retrospective analysis of its timing Barth, Claire Colombet, Isabelle Montheil, Vincent Huillard, Olivier Boudou-Rouquette, Pascaline Tlemsani, Camille Alexandre, Jérôme Goldwasser, François Vinant, Pascale BMC Palliat Care Research Article BACKGROUND: Palliative care (PC) referral is recommended early in the course of advanced cancer. This study aims to describe, in an integrated onco-palliative care program (IOPC), patient’s profile when first referred to this program, timing of this referral and its impact on the trajectory of care at end-of-life. METHODS: The IOPC combined the weekly onco-palliative meeting (OPM) dedicated to patients with incurable cancer, and/or the clinical evaluation by the PC team. Oncologists can refer to the multidisciplinary board of the OPM the patients for whom goals and organization of care need to be discussed. We analyzed all patients first referred at OPM in 2011–2013. We defined the index of precocity (IP), as the ratio of the time from first referral to death by the time from diagnosis of incurability to death, ranging from 0 (late referral) to 1 (early referral). RESULTS: Of the 416 patients included, 57% presented with lung, urothelial cancers, or sarcoma. At first referral to IOPC, 76% were receiving antitumoral treatment, 63% were outpatients, 56% had a performance status ≤2 and 46% had a serum albumin level > 35 g/l. The median [1st-3rd quartile] IP was 0.39 [0.16–0.72], ranging between 0.53 [0.20–0.79] (earliest referral, i.e. close to diagnosis of incurability, for lung cancer) to 0.16 [0.07–0.56] (latest referral, i.e. close to death relatively to length of metastatic disease, for prostate cancer). Among 367 decedents, 42 (13%) received antitumoral treatment within 14 days before death, and 157 (43%) died in PC units. CONCLUSIONS: The IOPC is an effective organization to enable early integration of PC and decrease aggressiveness of care near the end-of life. The IP is a useful tool to model the timing of referral to IOPC, while taking into account each cancer types and therapeutic advances. BioMed Central 2020-03-12 /pmc/articles/PMC7069048/ /pubmed/32164672 http://dx.doi.org/10.1186/s12904-020-0539-x Text en © The Author(s). 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Barth, Claire
Colombet, Isabelle
Montheil, Vincent
Huillard, Olivier
Boudou-Rouquette, Pascaline
Tlemsani, Camille
Alexandre, Jérôme
Goldwasser, François
Vinant, Pascale
First referral to an integrated onco-palliative care program: a retrospective analysis of its timing
title First referral to an integrated onco-palliative care program: a retrospective analysis of its timing
title_full First referral to an integrated onco-palliative care program: a retrospective analysis of its timing
title_fullStr First referral to an integrated onco-palliative care program: a retrospective analysis of its timing
title_full_unstemmed First referral to an integrated onco-palliative care program: a retrospective analysis of its timing
title_short First referral to an integrated onco-palliative care program: a retrospective analysis of its timing
title_sort first referral to an integrated onco-palliative care program: a retrospective analysis of its timing
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7069048/
https://www.ncbi.nlm.nih.gov/pubmed/32164672
http://dx.doi.org/10.1186/s12904-020-0539-x
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