Early palliative care in advanced cancer: Is it really effective?

Background Palliative care units (PCU) have shown an improvement in the quality of life of patients with cancer by reducing overtreatments at the end of life and increasing symptomatic care at home, avoiding unnecessary emergency room visits and decreasing the number of hospital admissions. Methods A retrospective observational study was conducted, selecting all patients with a first consultation in the Medical Oncology Unit of the Puerta de Hierro University Hospital (HUPdH) between 2014 and 2015 and died before December 31st 2017. Assessment by PCU, number of hospital admissions and re-admissions and most frequent symptoms for admission in the last 6 months of life were reviewed. The main objective was to know if there were differences between those who were valued by PCU or not. Results A total of 662 patients were selected. From them, 86 (13%) patients had never been admitted at HUPdH, 312 (47%) had been admitted once, 169 (26%) twice and 95 (14%) three or more times. Before death, 474 (72%) had been valued by PCU and 302 did not received PCU visit before the second hospital admission episode. The three most frequent causes of admission were deterioration of the general condition, infections and uncontrollable pain. In those with an assessment by PCU before the second admission process, there was a significant decrease in the number of readmissions (25% versus 68%). Moreover, in these patients, there was a statistically significant decrease in the number of re-admissions because of the three main causes of admission but also in others, such as dyspnea, neurological worsening, bleeding and nauseas and vomiting. (Table). Table . 1606P PCU: Percentage of patients re-admitted with an assessment by palliative care unit by the time of re-admission; Non PCU: Percentage of patients re-admitted without assessment by palliative care units before re-admission Symptom PCU Non PCU Risk Ratio Deterioration of the general condition 9% 21% RR 0.41, 95% CI 0.27-061, p Dyspnea 3% 13% RR 0.24, 95% CI 0.12-0.45, p Neurological worsening 2% 8% RR 0.25, 95% CI 0.11-0.56, p Infections 5% 24% RR 0.20, 95% CI 0.12-0.32, p Uncontrollable pain 5% 15% RR 0.35, 95% CI 0.21-0.59, p Nauseas and vomiting 2% 7% RR 0.32, 95% CI 0.14-0.71, p Bleeding 2% 7% RR 0.34, 95% CI 0.15-0.75%, p Conclusions In our cohort, in patients with an assessment by PCU before the second admission episode, was observed a decrease in number and severity of re-admissions. An optimization of the symptomatic treatment at home implies a decrease in hospital-acquired or nosocomial complications which leads to a reduction in costs and above all, an improvement in the quality life both of patients and their families. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.