The impacts of integrating palliative care in a community oncology practice: A retrospective cohort study.

Abstract

319 Background: Specialized palliative care integrated into oncology has demonstrated improved patient outcomes by managing physical and mental symptoms for patients with cancer. However, the objective impact of this approach in a community practice has been incompletely characterized. We sought differences in healthcare utilization, advance care planning (ACP), and hospice referral in patients receiving palliative care in a community oncology setting versus standard care. Methods: We conducted an IRB-approved retrospective cohort study in an adult population treated at a community-based oncology clinic in the United States. A set of age, stage, and histology matched cohorts were identified. Patients receiving integrated palliative care were labeled Cohort A (n = 450). Patients receiving standard oncology care were named Cohort B (n = 450). Clinical data was identified through the electronic medical record and de-identified through REDCap software. Multi-variate analysis was performed adjusting for age, stage, and cancer type. Outcomes were analyzed using a two-sample t-test or chi-square tests (α = 0.05). Post-hoc analyses were performed for key outcomes. Results: The cohorts were predominantly White (89% cohort A vs 96% cohort B, p <0.01) with a modest difference in mean age (71.5 vs 75.7, p < 0.001) respectively. Cohort A had a higher proportion of patients with stage III-IV disease (76% vs 64%, p < 0.001). Cohort A had a higher number of both ED visits (p < 0.01) and inpatient hospital admissions (p < 0.05) compared to Cohort B. ACP documentation and hospice referral occurred more often in Cohort A than Cohort B (both p < 0.0001). No differences were seen in ICU admissions. Post-hoc analyses demonstrated adequate power in observed differences between all outcomes. Conclusions: An integrative palliative care in community oncology was associated with an increase in ED utilization, inpatient admissions but also increases ACP documentation and hospice referrals. Differences in healthcare utilization should be interpreted cautiously given a severe disease population and the retrospective analysis. These findings suggest that patients who receive palliative care may have earlier and more thorough planning for end-of-life care.