Early integration of palliative care facilitates the discontinuation of anticancer treatment in women with advanced breast or gynecologic cancers

Gynecol Oncol. 2014 Nov;135(2):249-54. doi: 10.1016/j.ygyno.2014.08.030. Epub 2014 Aug 27.

Abstract

Objectives: To evaluate some health indicators in women with advanced breast or gynecological cancers (ABGCs) after discontinuation of active cancer treatment in function of the model of care received.

Methods: This prospective study included patients who were discontinuing anticancer treatment to be followed up only with palliative care (PC). Patients who had been evaluated at least once in PC were categorized as the integrated care model (ICM); those who had not been consulted by the PC team before, as the traditional care model (TCM). Data were analyzed using chi-square, Mann-Whitney, Kaplan-Meier, and Cox regression model.

Results: Among the 87 patients included in the study, 37 (42.5%) had been previously evaluated by the PC team (ICM). Patients who were followed up under an ICM exhibited better QoL (global health, p=0.02; emotional functioning, p=0.03; social functioning, p=0.01; insomnia, p=0.02) and less depression (p=0.01). The communication process had no issues in 73% of cases from the ICM group compared with 42% of cases from the TCM group (p=0.004). Patients who were not previously evaluated in PC received more chemotherapy in the last 6weeks of life compared to those who had already been evaluated (40% versus 5.9%, p=0.001). Early evaluation in PC was one of the independent prognostic factors of overall survival.

Conclusion: When followed up concurrently by a PC and clinical oncology team, patients reported better QoL and less depression, received less chemotherapy within the last 6weeks of life and survived longer than those followed up under a TCM.

Keywords: Chemotherapy; Neoplasms; Palliative care; Transition of care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use
  • Breast Neoplasms / pathology
  • Breast Neoplasms / psychology*
  • Breast Neoplasms / therapy
  • Communication
  • Depression / psychology
  • Disease Management
  • Female
  • Genital Neoplasms, Female / pathology
  • Genital Neoplasms, Female / psychology*
  • Genital Neoplasms, Female / therapy
  • Humans
  • Middle Aged
  • Palliative Care / methods
  • Palliative Care / psychology*
  • Proportional Hazards Models
  • Prospective Studies
  • Quality of Life*
  • Referral and Consultation / statistics & numerical data*
  • Sleep Initiation and Maintenance Disorders / psychology
  • Time Factors
  • Withholding Treatment*
  • Young Adult

Substances

  • Antineoplastic Agents