Palliative Care Consultations in Patients With Cancer: A Mayo Clinic 5-Year Review — JOP

* Copyright © 2011 by American Society of Clinical Oncology

Palliative Care Consultations in Patients With Cancer: A Mayo Clinic 5-Year Review

1. Arif H. Kamal, MD,
2. Keith M. Swetz, MD,
3. Elise C. Carey, MD,
4. Andrea L. Cheville, MD,
5. Heshan Liu, MS,
6. Suzanne R. Ruegg, RN, CNS,
7. Timothy J. Moynihan, MD,
8. Jeff A. Sloan, PhD and
9. Judith S. Kaur, MD

+ Author Affiliations

1. Mayo Clinic, Rochester, MN

1. Corresponding author: Keith M. Swetz, MD, Division of General Internal Medicine, Palliative Medicine Program, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: swetz.keith@mayo.edu.

Abstract

Purpose: We sought to characterize the aggregate features and survival of patients who receive inpatient palliative care consultation, particularly focusing on patients with cancer, to identify opportunities to improve clinical outcomes.

Methods: We reviewed prospectively collected data on patients seen by the Palliative Care Inpatient Consult Service at Mayo Clinic (Rochester, MN) from January 2003 to September 2008. Demographics, consultation characteristics, and survival were analyzed using Kaplan-Meier survival curves and Cox survival models.

Results: Cancer was the most common primary diagnosis (47%) in the 1,794 patients seen over the 5-year period. A significant growth in the annual number of palliative care consultations has been observed (113 in 2003 v 414 in 2007), despite stable total hospital admissions. Frequently encountered reasons for consultation included clarification of care goals (29%), assistance with dismissal planning (19%), and pain control (17%). Although patients with cancer had the highest median survival after consultation in this cohort versus patients with other diagnoses, we observed a 5-year trend of decreasing survival from admission to death and from consultation to death. Median time from admission to death for patients with cancer was 36 days in 2003 and only 19 days in 2008 (P < .01). Median time from consultation to death decreased from 33 days in 2003 to only 11.5 days in 2008 (P < .01). Conclusion: Patients with cancer often have complex needs that must be met within a short window for intervention. We highlight opportunities for improved multidisciplinary care for patients with advanced cancer and their families, including opportunity for earlier palliative care involvement, even in the outpatient setting. * Accepted September 20, 2010. Palliative Care Consultations in Patients With Cancer: A Mayo Clinic 5-Year Review — JOP