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Title: Comparison of Healthcare Utilization, Quality of Life, and Survival Among Patients Referred to Palliative Medicine Versus Standard Oncologic Care

Names and Affiliations

  • Dumindra Gurusinghe, MD, UCSF Fresno
  • Ryan Howard, MD, UCSF Fresno
  • Regina Laico, MD, UCSF Fresno
  • Mir Ali, MD, UCSF Fresno
  • Susan Hughes, MS, UCSF Fresno
  • Norr Santz, MD, The Oncology Institute of Hope and Innovation
  • Nicole Jernick, MD, UCSF Fresno
  • Patrick Macmillan, MD, UCSF Fresno
  • Alireza Soleimani Fard, MD, UCSF Fresno

Background/Objective: We will examine differences in functional status, healthcare utilization, and survival between patients who received standard oncologic care versus standard oncologic care plus palliative care services.

Methods/Study Design: This case-control study will review the electronic medical records of patients from one oncology clinic seen between February 2016 and February 2018. Cases will have received a palliative care clinic referral while controls will not.  Cases will be matched by type and stage of cancer, treatment intention at diagnosis (curative versus non-curative), and Charlson comorbidity index.

Outcomes: Supportive services use, advance care planning, rates of emergency department utilization and hospitalization, enrollment in comfort care and hospice, and survival time from initial diagnosis.

Results/Analysis: Preliminary findings are for cases only. Two hundred twenty-five patients received a palliative care clinic referral; 53% were male, median age was 60 years (range from 23 to 90), 47% were White, 37% were Hispanic, 35% had gastrointestinal cancer while 19% had lung cancer, the median Charlson comorbidity index score was 8, median functional status was ECOG 1, and treatment intent was curative for 37% at time of diagnosis. Supportive services included nursing, social work, dietary, and speech therapy, with a median number of support visits 0, 2, 1, and 0, respectively. Twenty-eight percent of patients had an advance directive while 37% had a Physician Orders for Life-Sustaining Treatment (POLST) on record. Forty-eight percent enrolled in comfort care or hospice, with a median survival length of 17 days.

Conclusions/Interpretations:  Data collection is continuing; additional results and analysis anticipated by time of presentation.