Outcomes of supportive/palliative care (SPC) for advanced cancer patients (AdCa) in a general public hospital and a comprehensive cancer center.

208 Background: AdCa experience severe physical, psychosocial and existential distress. Their needs might not be met only by standard care. We compared outcomes of AdCa receiving SPC at a General Public Hospital (GPH) and at a Comprehensive Cancer Center (CCC).We reviewed 364 consecutive AdCa(182 at GPH and 182 at CCC). AdCa were managed by SPC-specialists with common clinical-pathways. We assessed symptoms(Edmonton Symptom Assessment System:ESAS) and outcomes at consult and first follow-up.Race was White, African-American, and Hispanic in 42(23%), 70(39%), 63(35%) at GPH vs. 112(64%, p<0.0001), 30(17%, p<0.0001), 20(11%, p<0.0001) at CCC, respectively. Age, gender and cancer diagnoses were similar at both sites. 98(54%) at GPH vs. 181(99%) at CCC reported to have some health-insurance(p<0.0001). Symptoms at consult-time at GPH and CCC: Pain 133(85%) vs. 151(91%,p=0.0586); Fatigue 127(80%) vs. 153(94%,p<0.0001); Nausea 69(44%) vs. 89(55%,p=0.0438); Depression 79(51%) vs. 109(68%,p=0.0015); Anxiety 72(46%) vs. 121(75%,p<0.0001); Drowsiness 78(50%) vs. 119(76%, p<0.0001); Appetite 89(56%) vs. 146(91%, p<0.0001); Dyspnea 72(46%) vs. 107(65%,p=0.0004); Sleep 90(59%) vs. 142(88%,p<0.0001); and Well-Being 95(63%) vs. 132(93%,p<0.0001). Both SPC provided multiple not different interventions: opioid-management, medication review for polypharmacy, bowel-regimen, antiemetics, and interdisciplinary counseling. At follow-up ESAS-improvement(decrease ≥2 points) was: pain 21/80(26%) at GPH vs. 43/107(40%) at CCC(p=0.0469), anxiety 18/75(24%) vs. 40/98(41%,p=0.0202); appetite 15/74(20%) vs. 37/90(41%,p=0.0043); sleep 20/74(27%) vs. 42/95(44%,p=0.0215); nausea 23/77(30%) vs. 35/97(36%,p=0.3879); depression 18/74(24%) vs. 30/94(32%,p=0.2796). Median Time(range) from consult-to-follow-up at GPH 21 days(0-427) vs. 14 days(1-275,p=0.032), and from consult-to-death at GPH 53 days(1-699) vs. 51 days(1-898,p=0.8473).AdCa at GPH and CCC had frequent and severe-symptoms. Response-rate was lower and follow-up less-frequent at GPH. SPC needs to be more frequent and more resources are needed at GPH.