Routine Use of Palliative Care Underutilized in Ovarian Cancer

02/13/18

A study soon to published found that palliative care for patients with ovarian cancer was often provided later than recommended in national guidelines.

The American Society of Clinical Oncology (ASCO) recommends that patients with advanced cancer receive dedicated palliative care early in their disease course.

Whitfield B Growdon, MD, division of gynecologic oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, and colleagues conducted a study to investigate how palliative care services are utilized for patients with ovarian cancer in a tertiary referral center. A retrospective review was conducted of women treated for ovarian cancer at Massachusetts General Hospital from 2010 through 2015.

Clinical variables that researchers considered were presence and timing of palliative care referral. Univariable and multivariable parametric and non-parametric testing was utilized to correlate data. Kaplan-Meier models and Cox-proportional hazard models were utilized to analyze survival trends.

The study is in press and published in Gynecologic Oncology (online February 3, 2018; doi:10.1016/j.ygyno.2018.01.018).

Among the 391 women treated for ovarian cancer in the study, 68% were diagnosed with stage III/IV disease. Palliative care was referred in 28% of patients in the outpatient (42%) and inpatient (58%) setting. Additionally, researchers noted that earlier use of referral was observed in patients who never underwent surgical cytoreduction or had interval cytoreductive surgery (P < .001).

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Researchers found that palliative care referral was independently associated with advanced stage, recurrence, and hospice referral. Palliative care referral occurred within 30 days of death in 38% of patients, and 17% of patients within 7 days of death. Furthermore, outpatient initial consultation was associated with an unadjusted 1-year overall survival benefit (P < .01) compared with inpatient consultation.

“The outcomes in this study suggest a late use of palliative care that is reactionary to patient needs and not a routine component of ovarian cancer care as national guidelines recommend,” authors of the study concluded.—Zachary Bessette