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Recommending early integration of palliative care — does it work?

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Abstract

Background

In 2006, our comprehensive cancer center decided to implement early integration (EI) of palliative care (PC) by (a) literally adopting the WHO definition of PC into cancer care guidelines and (b) providing a PC consulting team (PCST) to provide EI on in- and outpatient wards. The experience with this approach was assessed to identify shortcomings.

Methods

A retrospective systematic chart analysis of a 2-year period was performed.

Results

A total of 862 patients were treated (May 2006–April 2008). Many patients consulted by the PCST for the first time were already in a reduced performance status (ECOG 3 & 4: 40%) or experiencing burdening symptoms (i.e., dyspnoea 27%). After the first year (period A; “getting started”), the overall prevalence of symptoms identified on first PC contact decreased from seven to three, (p < 0.001) as well as surrogate measures for advanced disease (i.e., frailty: from 63% to 33%; CI: [−36%; −23%], p < 0.001).

Conclusion

Surrogate measures (symptom burden, performance status) indicate that PC was integrated earlier in the course of the disease after a 1-year phase of “getting started” with EI. Yet, the WHO recommendation alone was too vague to successfully trigger EI of PC. Therefore, the authors advocate the provision of disease specific guidelines to institutionalize EI of PC. Such guidelines have been developed for 19 different malignancies and are presented separately.

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Acknowledgment

The scientific work of the Department of Palliative Medicine, University Clinic of Cologne is supported by the Federal Ministry for Education and Science (BMBF 01KN0706). The clinical and academic activities of the Department of Palliative Medicine, University Clinic of Cologne, are substantially supported by the German Cancer Aid (Deutsche Krebshilfe e.V.).

Disclaimer

The work has not yet been presented elsewhere.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Palliative Medicine, University Hospital, Kerpener Strasse 62, 50937, Cologne, Germany

    Jan Gaertner, Sebastian Frechen, Ursula Klein, Dennis Scheicht & Raymond Voltz

  2. Department of Internal Medicine I, University Hospital, Cologne, Germany

    Juergen Wolf, Karin Toepelt, Jan-Peter Glossmann & Michael Hallek

  3. Center for Integrated Oncology, University Hospital, Cologne/Bonn, Germany

    Jan Gaertner, Juergen Wolf, Martin Hellmich, Karin Toepelt, Jan-Peter Glossmann, Michael Hallek & Raymond Voltz

  4. Institute of Medical Statistics, Informatics and Epidemiology, Cologne, Germany

    Martin Hellmich

  5. Clinical Trials Center Cologne BMBF 01KN0706, Cologne, Germany

    Jan Gaertner & Raymond Voltz

  6. Department of Palliative Care, University of Erlangen, Erlangen, Germany

    Christoph Ostgathe

Authors
  1. Jan Gaertner
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  2. Juergen Wolf
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  3. Sebastian Frechen
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  4. Ursula Klein
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  5. Dennis Scheicht
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  6. Martin Hellmich
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  7. Karin Toepelt
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  8. Jan-Peter Glossmann
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  9. Christoph Ostgathe
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  10. Michael Hallek
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  11. Raymond Voltz
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Corresponding author

Correspondence to Jan Gaertner.

Additional information

Jan Gaertner and Juergen Wolf have contributed equally to the manuscript.

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Gaertner, J., Wolf, J., Frechen, S. et al. Recommending early integration of palliative care — does it work?. Support Care Cancer 20, 507–513 (2012). https://doi.org/10.1007/s00520-011-1111-2

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  • DOI: https://doi.org/10.1007/s00520-011-1111-2

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