Rutgers New Jersey Medical School, Newark, NJ
Sarah Lee , Zhen Wang , Sejal Kothadia , Yucai Wang , Ellen Olson , Yeun-Hee Anna Park , David Klein , Fengming Zhong , Victor Tsu-Shih Chang
Background: Liver cancer is a leading cause of death. Lack of data exists on palliative care in this group, and care varies by location. We aim to determine if there are differences in palliative care for liver cancer patients (pts) by VA site. Methods: In an IRB approved protocol, we reviewed medical records of pts at 2 VA medical centers (S1, S2) with liver cancer, who were seen by Palliative Care between 2006 and 2012. Veterans were compared by 1) demographics: Karnofsky performance status > 50 (KPS), marital status, DNR/DNI, 2) palliative intervention: goals of care discussion, referrals to psychology and PT/OT, and 3) outcomes: ED visit within 1 month (mo) of death, ED visit within 6 mo of death, ICU within 30 days of death, and hospice as site of death, time from diagnosis to palliative care, and time from DNR to death. Chi-square, Fisher’s Exact, and T-test were performed with Stata. Results: There were 82 men, 30 from S1 and 52 from S2, median age 61 (35-87) and 63 (54-88) yrs, respectively. Pts were Caucasian 30 (36%), African American 47 (57%), and other 5 (0.1%). Cancer stages were locoregional 15 (50%), metastatic 13 (43%), and unknown 2 (0.1%) at S1 and 28 (54%), 20 (38%), 5 (0.1%) at S2. Differences were seen in KPS > 50: (S1, S2) [10 (33%), 15(29%) p = 0.010], married: (S1, S2) [7 (23%), 24(46%) p = 0.024], DNR/DNI: (S1, S2) [19 (63%), 13(25%), p = 0.001]. Regarding palliative intervention: goals of care discussion (S1, S2) [26 (87%), 44 (85%), p = 0.044], referral to psych (S1, S2) [16 (53%), 42 (81%) p = 0.014], referral to PT/OT (S1, S2) [17 (57%), 15 (29%), p = 0.007]. Finally in regards to outcome: ED visit within 1 mo of death (S1, S2) [7 (23%), 31 (60%), p = 0.001], ED visit within 6 mos of death (S1, S2) [18 (56%), 35 (67%) p = 0.031], ICU within 30 days of death (S1, S2) [0 (0%), 9 (17%) p = 0.019}, and hospice as site of death (S1, S2) [19 (63%), 21 (40%), p < .0001]. Other key differences included median number of days from diagnosis to initial palliative care consult (S1, S2) [97, 39, p = 0.001] and median number of days from DNR to death (S1, S2) [33, 14, p = 0.001]. Conclusions: Results show there are site specific differences between VA medical centers. These data may be important in the comparison of other centers and provide a baseline for future studies.
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Abstract Disclosures
2016 Palliative and Supportive Care in Oncology Symposium
First Author: Sarah Lee
2018 Palliative and Supportive Care in Oncology Symposium
First Author: Kathleen Elizabeth Bickel
2021 ASCO Quality Care Symposium
First Author: Megan Healy
2022 ASCO Annual Meeting
First Author: Vinit Singh