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Annals of Oncology
care (PC) consultation (defined as a physician consultation focusing on PC needs,
lasting at least 40 minutes) could reduce overly aggressive care in this population.
Purpose: To examine the impact of PC consultation on (i) subsequent use of
chemotherapy within 14 days of death; (ii) more than one emergency department
(ED) visit; (iii) more than one hospitalization; and (iv) at least one intensive care
unit (ICU) admission, all within 30 days of death.
Methods: A retrospective population-based cohort study using linked administrative
databases was conducted with patients diagnosed with advanced pancreatic cancer
from Jan 1 2005 to Dec 31 2010. Analysis was limited to those who had received
palliative chemotherapy. Multivariable logistic analyses were performed with the
above quality indicators as the outcomes of interest and PC as the main covariate,
adjusting for other variables (age, sex, rurality, and health region).
Results: Of the 6076 patients who had advanced pancreatic cancer, 5381 of these
patients had died at last follow-up, and 1644 of those had received palliative
chemotherapy. In this cohort, 986 (60%) received a palliative care consultation, 218
(13%) received chemotherapy near death, 53 (3%) patients went to the ICU near
death, 218 (13%) had multiple ED visits near death, and 213 (13%) had multiple
hospitalizations near death. In multivariable analysis, PC consultation was associated
with decreased use of chemotherapy near death (odds ratio (OR) 0.23; 95%
confidence interval (CI) 0.17-0.32), and lower risk of ICU admission near death (OR
0.19; 95% CI 0.10-0.36), multiple ED visits near death (OR 0.41; 95% CI 0.30-0.55),
and multiple hospitalizations near death (OR 0.37; 95% CI 0.27-0.50).
Conclusions: In patients with advanced pancreatic cancer who are receiving
palliative chemotherapy, PC involvement is associated with less frequent overly
aggressive care. Future analysis will explore the effect of timing of PC consultation
(early vs late) on outcomes, and expand the cohort to all patients with advanced
disease.
Disclosure: All authors have declared no conflicts of interest.
1433P FACTORS ASSOCIATD WITH SURROGATE
DECISION-MAKING IN ADVANCED CANCER PATIENTS:
A LONGITUDINAL STUDY
D. Heo, J.K. Lee, A. An, B. Keam, T. Kim, S. Lee, D. Kim
Internal Medicine, Seoul National University Hospital, Seoul, KOREA
Purpose: Although surrogate decision-making in cancer patients is well-known, few
studies investigating the prevalence of surrogate decision-making over time have been
reported. The objectives of this study were to investigate the level of surrogate
decision-making in advanced cancer patients over time and the impact of
demographic and clinical variables on surrogate decision-making.
Methods: The level of surrogate decision-making was measured in 572 consecutive
cancer patients who died between January 1 and December 31, 2009. We reviewed
8,639 informed consent forms of these patients, calculated the proportion of
decisions made by a surrogate (PDS) for each patient, and analyzed the association
of PDS with demographic and clinical variables.
Results: Surrogates completed 40.3% of all consent forms. The prevalence of
surrogate decision-making was higher in the end-of-life period (death 365 days). Surrogates signed consent forms more frequently for
do-not-resuscitate directives, intensive care unit admission, emergency hemodialysis,
surgery and invasive interventions compared with chemotherapy, radiotherapy, and
diagnostic tests (OR = 3.88, P < 0.001). Patients of older age (P = 0.036) and those
with a shorter duration of management (P < 0.001) were independently associated
with greater PDS.
Conclusions: Surrogate decision-making was frequently observed among Korean
cancer patients in this study, especially when the patient’s death was imminent, and
for decisions related to end-of-life care. Surrogates were also frequently involved in
decisions for elderly or rapidly deteriorating patients. Healthcare professionals should
consider the significant role of familial surrogates in the end-of-life period;
comprehensive approaches are needed to preserve the best interest of the patients.
Disclosure: All authors have declared no conflicts of interest.
1434P THE UNDERSTANDING OF TERMINAL CANCER AND ITS
RELATIONSHIP WITH ATTITUDES TOWARD END-OF-LIFE
CARE ISSUES
J.K. Lee 1 , D.S. Heo 1 , A.R. An 2 , Y.H. Yun 3
1 Internal Medicine, Seoul National University Hospital, Seoul, KOREA, 2 Family
Medicine, Seoul National University Hospital, Seoul, KOREA, 3 Department of
Medicine, Seoul National University, Seoul, KOREA
Objective: To investigate differences in the understanding of terminal cancer and
determine the relationship between this understanding and attitudes toward
end-of-life issues.
Design: A questionnaire survey was performed between 2008 and 2009.Participants:
A total of 1242 cancer patients, 1289 family caregivers, 303 physicians from 17
university hospitals, and 1006 participants from the general population responded
(response rates: 90.1%, 95.1%, 81.0%, and 75.9%, respectively).
Main outcome measures: Individual understanding of terminal cancer and its
relationship with preference for disclosure of terminal prognosis and critical
end-of-life interventions.
Results: A “six-month life expectancy” was the most common understanding of
terminal cancer (45.6%), followed by “treatment refractoriness” (21.1%),
“metastatic/recurred disease” (19.4%), “survival of a few days/weeks” (11.4%),
and “locally advanced disease” (2.5%). The combined proportion of “treatment
refractoriness” and “six-month life expectancy” differed significantly between
physicians and the other groups combined (76.0% vs 65.9%, P = 0.0003).
Multivariate analyses showed that patients and caregivers who understood
terminal cancer as “survival of a few days/weeks” showed more negative
attitudes toward disclosure of terminal status compared with participants who
chose “treatment refractoriness” (adjusted odds ratio [aOR] 2.39, 95% CI 1.26
to 4.54 for patients; aOR 2.94, 95% CI 1.58 to 5.47 for caregivers). Caregivers
who understood terminal cancer as “metastatic/recurred” or “six-month
survival” tended to disagree with withdrawing futile life-sustaining treatments
(aOR 2.57, 95% CI 1.39 to 4.75 for “metastatic/recurred,” aOR 1.86, 95% CI
1.06 to 3.28 for “six-month survival”) and active pain control (aOR 2.29, 95%
CI 1.13 to 4.64 for “metastatic/recurred”, aOR 1.86, 95% CI 0.97 to 3.54 for
“six-month survival”), compared with caregivers who selected “treatment
refractoriness.”
Conclusion: The understanding of terminal cancer varies among the four participant
groups. It was associated with different preferences regarding end-of-life issues.
Standardizing this terminology is needed to better understand end-of-life care.
Disclosure: All authors have declared no conflicts of interest.
1435P THE CHARATERISTICS OF PALLIATIVE CARE IN A RURAL
EUROPEAN REGION
T. Sternfeld 1 , M. Flieser-Hartl 2 , U. Vehling-Kaiser 1
1 Onkologische Schwerpunktpraxis, Onkologisches und Palliativmedizinisches
Netzwerk Landshut, Landshut, GERMANY, 2 Krankenhaus Landshut-achdorf,
Onkologisches und Palliativmedizinisches Netzwerk Landshut, Landshut,
GERMANY
The palliative care unit Landshut is one of the few centres accredited by the ESMO
serving in a rural area (Lower Bavaria, Germany). It is part of the Network for
Oncology and Palliative Care Medicine Landshut (Onkologisches und
Palliativmedizinisches Netzwerk Landshut) which has been accredited 2010 by the
ESMO as Designated Centre of Integrated Oncology and Palliative Care and the
DGHO in 2011. The Network aims to improve the palliative care service with
regard to the special needs of the rural cancer population. Data regarding palliative
care of tumor patients in rural areas of Europe are lacking. In December 2010, a
continuous data acquisition for patients on the palliative care unit located at the
Hospital Landshut-Achdorf was started. We now present a cross sectional data
analysis. Between December 2010 and March 2012, 499 patients were admitted for
the first time to the palliative care unit. The majority of these patients were living
outside the town boundaries, mainly in small villages. 84% of the patients were
diagnosed with a solid tumour, 6% with a haematological malignancy, and 10% had
a non-malignant disease. Before their first admission, 50% of the patients were
treated with opioids, 44% of the patients had a central venous port system, 4% a
gastric tube, and 10% had received parenteral nutrition. The most frequent
symptoms leading to admission were reduced general health status (43%),
uncontrolled pain (20%), dyspnoea (14%), nausea (8%), confusion (3%), and
insufficient social support (3%). 48% of the patients died during the first admission.
The mean time of hospitalization was 11 ± 7 days. After discharge from hospital,
37% were cared for by themselves or family members, 23% were visited by a
community nurse or other nursing services, 19% were cared for by the outpatient
palliative care program, 14% were admitted to a nursing home, 4% were transferred
to another ward, and 3% to the hospice which had opened as recently as January
2012. Detailed data of the hospitalized palliative patients are presented and further
discussed regarding the special needs of the growing rural palliative patient
population.
Disclosure: All authors have declared no conflicts of interest.
Volume 23 | Supplement 9 | September 2012 doi:10.1093/annonc/mds411 | ix465