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Palliative care referral patterns and measures of aggressive care at the end of life in patients with cervical cancer
  1. Alexandra S Bercow1,2,
  2. Roni Nitecki3,
  3. Hilary Haber1,2,
  4. Allison A Gockley4,
  5. Emily Hinchcliff3,
  6. Kaitlyn James5,
  7. Alexander Melamed4,
  8. Elisabeth Diver6,
  9. Mihir M Kamdar7,
  10. Sarah Feldman8 and
  11. Whitfield B Growdon9
  1. 1Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  3. 3Gynecologic Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  4. 4Department of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA
  5. 5Deborah Kelly Center for Clinical Research, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
  6. 6Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
  7. 7Division of Palliative Care, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  8. 8Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  9. 9Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Whitfield B Growdon, Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, USA; WGROWDON{at}MGH.HARVARD.EDU

Abstract

Introduction Fifteen per cent of women with cervical cancer are diagnosed with advanced disease and carry a 5 year survival rate of only 17%. Cervical cancer may lead to particularly severe symptoms that interfere with quality of life, yet few studies have examined the rate of palliative care referral in this population. This study aims to examine the impact of palliative care referral on women who have died from cervical cancer in two tertiary care centers.

Methods We conducted a retrospective review of cervical cancer decedents at two tertiary institutions from January 2000 to February 2017. We examined how aggressive measures of care at the end of life, metrics defined by the National Quality Forum, interacted with clinical variables to understand if end-of-life care was affected. Univariate and multivariate parametric and non-parametric testing was used, and linear regression models were generated to determine unadjusted and adjusted associations between aggressive measures of care at the end of life with receipt of palliative care as the main exposure.

Results Of 153 cervical cancer decedents, 73 (47%) received a palliative care referral and the majority (57%) of referrals occurred during an inpatient admission. The median time from palliative care consultation to death was 2.3 months and 34% were referred to palliative care in the last 30 days of life. Palliative care referral was associated with fewer emergency department visits (OR 0.18, 95% CI 0.05 to 0.56), inpatient stays (OR 0.21, 95% CI 0.07 to 0.61), and intensive care unit admissions (OR 0.24, 95% CI 0.06 to 0.93) in the last 30 days of life. Palliative care did not affect chemotherapy or radiation administration within 14 days of death (p=0.36). Women evaluated by palliative care providers were less likely to die in the acute care setting (OR 0.19, 95% CI 0.07 to 0.51).

Discussion In two tertiary care centers, less than half of cervical cancer decedents received palliative care consultations, and those referred to palliative care were often evaluated late in their disease course. Palliative care utilization was also associated with a lower incidence of poor-quality end-of-life care.

  • cervical cancer
  • quality of life (pro)/palliative care
  • palliative care
  • pain
  • cancer pain
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Footnotes

  • Twitter @AlexBercowMD

  • Presented at These data were initially presented at the Society of Gynecologic Oncology’s 2020 Winter Meeting in Aspen, CO, USA.

  • Contributors ASB, RN, and WBG conceived of the idea. ASB and HH carried out the implementation. ASB, HH, AAG, EH, AM, ED all contributed to data collection. WBG and KJ provided statistical analysis. ASB wrote the manuscript. All authors provided critical feedback and helped shape the research, analysis and manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SF reports personal fees from UpToDate during the conduct of the study.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Deidentified participant data available upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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