Characteristics and Outcomes of Advanced Cancer Patients Who Received Palliative Care at a Public Hospital Compared with Those at a Comprehensive Cancer Center

Marvin Omar Delgado-Guay, Jeannette Ferrer, Jewel Ochoa, Hilda Cantu, Janet L. Williams, Minjeong Park, Eduardo Bruera

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Background: Patients with advanced cancer experience severe physical, psychosocial, and spiritual distress requiring palliative care (PC). There are limited literature regarding characteristics and outcomes of patients evaluated by PC services at public hospitals (PHs). Objective, Design, Setting/Subjects, and Measurements: To compare the outcomes of advanced cancer patients undergoing PC at a PH and those at a comprehensive cancer center (CCC). We reviewed 359 consecutive advanced cancer patients (PH, 180; CCC, 179) undergoing PC. Symptoms and outcomes at consultation and first follow-up visit were assessed. Summary statistics were used to describe patient characteristics and outcomes. Results: The PH and CCC patients differed significantly according to race: 23% white, 39% black, and 36% Hispanic patients at the PH versus 66% white, 17% black, and 11% Hispanic patients at the CCC (p < 0.0001). Ninety-six (53%) patients at PH and 178 (99%) at the CCC had health insurance (p < 0.0001). Symptoms at consultation at PH and CCC were pain (85% and 91%, respectively; p = 0.0639), fatigue (81% and 94%, respectively; p = 0.0003), depression (51% and 69%, respectively; p = 0.0013), anxiety (47% and 75%, respectively; p < 0.0001), and well-being (63% and 93%, respectively; p < 0.0001). Multiple interventions provided: opioids, reviews for polypharmacy, constipation management, and interdisciplinary counseling. Median time from outpatient consultation to follow-up was 29 days(range, 1-119 days) at the PH and 21 days (range, 1-275 days) at the CCC (p = 0.0006). Median overall survival time from outpatient consultation was 473 days (95% confidence interval [CI], 205-699 days) at PH and 245 days (95% CI, 152-491 days) at CCC (p = 0.3408). Conclusions: Advanced cancer patients at both institutions frequently had multiple distressing physical and emotional symptoms, although the frequency was higher at CCC. The median overall survival duration was higher at the PH. More research is needed.

Original languageEnglish (US)
Pages (from-to)678-685
Number of pages8
JournalJournal of palliative medicine
Volume21
Issue number5
DOIs
StatePublished - May 2018

Keywords

  • advanced cancer
  • comprehensive cancer center
  • palliative care
  • symptom distress

ASJC Scopus subject areas

  • General Nursing
  • Anesthesiology and Pain Medicine

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