Palliative care interventions and end-of-life care outcomes for hepatocellular patients (pts) at two Veterans Affairs (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 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 Palliative and Supportive Care in Oncology Symposium

Session Type

Poster Session

Session Title

Poster Session A

Track

Evaluation and Assessment of Patient Symptoms and Quality of Life,Integration and Delivery of Palliative Care in Cancer Care

Sub Track

Models of care delivery

Citation

J Clin Oncol 34, 2016 (suppl 26S; abstr 164)

DOI

10.1200/jco.2016.34.26_suppl.164

Abstract #

164

Poster Bd #

J4

Abstract Disclosures

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