Frequency, Timing, and Predictors of Palliative Care Consultation in Patients with Advanced Cancer at a Tertiary Cancer Center: Secondary Analysis of Routinely Collected Health Data

Sharon M Watanabe; Viane Faily; Asifa Mawani; Ann Huot; Yoko Tarumi; Alexei Potapov; Konrad Fassbender; Alysa Fairchild; Anil A Joy; Karen M King; Wilson Roa; Christopher P Venner; Vickie E Baracos

doi:10.1634/theoncologist.2019-0384

Frequency, Timing, and Predictors of Palliative Care Consultation in Patients with Advanced Cancer at a Tertiary Cancer Center: Secondary Analysis of Routinely Collected Health Data

Oncologist. 2020 Aug;25(8):722-728. doi: 10.1634/theoncologist.2019-0384. Epub 2020 Jun 9.

Authors

Sharon M Watanabe^{1

2}, Viane Faily¹, Asifa Mawani², Ann Huot¹, Yoko Tarumi^{1

2}, Alexei Potapov¹, Konrad Fassbender^{1

3}, Alysa Fairchild^{1

2}, Anil A Joy^{1

2}, Karen M King^{1

2}, Wilson Roa^{1

2}, Christopher P Venner^{1

2}, Vickie E Baracos¹

Affiliations

¹ University of Alberta, Edmonton, Alberta, Canada.
² Cross Cancer Institute, Edmonton, Alberta, Canada.
³ Covenant Health Palliative Institute, Edmonton, Alberta, Canada.

Abstract

Introduction: Early integration of palliative care (PC) with oncological care is associated with improved outcomes in patients with advanced cancer. Limited information exists on the frequency, timing, and predictors of PC consultation in patients receiving oncological care. The Cross Cancer Institute (CCI) is the sole tertiary cancer center serving the northern half of the Canadian province of Alberta, located in the city of Edmonton. The objectives of this study were to estimate the proportion of patients with advanced cancer at the CCI who received consultation by the CCI PC program and the comprehensive integrated PC program in Edmonton, and to determine the timing and predictors of consultation.

Materials and methods: In this secondary analysis of routinely collected health data, adult patients who died between April 2013 and March 2014, and had advanced disease while under the care of a CCI oncologist, were eligible. Data from the Alberta Cancer Registry, electronic medical records, and Edmonton PC program database were linked.

Results: Of 2,253 eligible patients, 810 (36%) received CCI PC consultation. Median time between consultation and death was 2 months (range, 1.1-5.4). In multivariable logistic regression analysis, age, residence, income, cancer type, and interval from advanced cancer diagnosis to death influenced odds of receiving consultation. Among 1,439 patients residing in Edmonton, 1,121 (78%) were referred to the Edmonton PC program.

Conclusion: A minority of patients with advanced cancer received PC consultation at the tertiary cancer center, occurring late in the disease trajectory. Frequency and timing of PC consultation varied significantly, according to multiple factors.

Implications for practice: Clinical and demographic factors are associated with variations in frequency and timing of palliative care consultation at a cancer center and may, in some cases, reflect barriers to access that warrant attention.

Keywords: Neoplasms; Oncologists; Palliative care; Referral and consultation.

MeSH terms

Adult
Canada
Humans
Neoplasms* / epidemiology
Neoplasms* / therapy
Palliative Care*
Referral and Consultation
Retrospective Studies
Routinely Collected Health Data