Palliative care interventions and EOL care outcomes for hepatocellular patients (pts) at 2 VA medical centers.

Authors

null

Zhen Wang

Rutgers New Jersey Medical School, Newark, NJ

Zhen Wang , Sarah Lee , Sejal Kothadia , Yucai Wang , Victor Tsu-Shih Chang , Yeun-Hee Anna Park , Ellen Olson , David Klein , Fengming Zhong

Organizations

Rutgers New Jersey Medical School, Newark, NJ, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, Section of Hematology/Oncology, VA New Jersey Health Care System, East Orange, NJ, Oncology and Hematology of White Plains, Mt Vernon, NY, James Jay Peters VA Medical Center, Bronx, NY, James J. Peters VA Medical Center, Bronx, NY, VA New Jersey Healthcare System, East Orange, NJ

Research Funding

Other

Background: Palliative care interventions and their effect on EOL outcomes for liver cancer pts have not been described. We investigated the association between palliative care intervention and EOL care outcomes. Methods: We reviewed the charts of pts with hepatocellular carcinoma and who were seen by palliative care at 2 VA medical centers from 2006 to 2012. We investigated the association between EOL outcomes (number of ER visits, ICU visits, chemotherapy, place of death, number of hospitalizations during their last 30 days), and interventions such as early referral (within 30 days of diagnosis), defined goals of care, holding a family meeting, and symptom assessment and management. The protocol was reviewed by the IRB of both VAs and analyses were done with SAS Studio v3.4. Results: 82 charts were reviewed (30 from EOVA and 52 from BVA). All Pts were men; 30 (39%) were white and 47(61%) African American. Interval from diagnosis to palliative care consult was 68 days (median). 72 (90%) pts were not aware of their diagnosis. 48 (65%) were not aware of prognosis. 65 (88%) had decision making capacity. 32 (39%) pts were DNR/DNI. 60 (86%) pts chose symptom management and 10 (14%) life prolongation. 47 pts (50%) had family meeting. In the last month, 35 pts (48%) had ER visit. 9 pts (12%) had ICU visits, 4 pts (5%) had chemotherapy and 48 pts (71%) had at least 1 hospitalization. 68 (85%) underwent symptom assessment. Most frequently treated symptoms were pain (78%), nausea (27%), constipation (46%), dyspnea (34%). Significant associations were found for early referral and ER admissions (OR = 3.2, p = 0.0178), family meeting and site of death (OR = 0.136 p = 0.0037), family meeting and number of hospitalizations (OR = 0.2652, p = 0.0169). Pts choosing symptom management and who had family meetings associated with hospice/home as place of death (chisq = 5.7368, p = 0.016). Knowledge of prognosis was not associated with site of death. Conclusions: In this population, many palliative care interventions were performed. Early referral, family meetings were significantly associated with site of death, ER admissions, and number of hospitalizations. These results should be replicated in larger studies.

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Abstract Details

Meeting

2016 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Patient and Survivor Care

Track

Patient and Survivor Care

Sub Track

End-of-Life Care

Citation

J Clin Oncol 34, 2016 (suppl; abstr e21514)

DOI

10.1200/JCO.2016.34.15_suppl.e21514

Abstract #

e21514

Abstract Disclosures

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