When will the palliative care evidence be translated into care?
An article written by Professor Jennifer Philip
It is now more than 10 years since Temel and colleagues published the landmark study in the New England Journal showing that early integration of palliative care for people with metastatic non-small cell lung cancer not only improved quality of life and psychological symptoms but also was associated with increased survival. We were interested to see the extent to which this evidence, and that from multiple other similar studies, was translated into practice in Victoria, Australia.
We, therefore, undertook a retrospective population cohort study of the health service use of all those people who had died from cancer in 2018. [1] We also compared these health service use data to a group of people with lung, breast, and prostate cancer who had died 10 years earlier (between 2005-2009) – that is before the Temel study was published.
Interestingly, despite all the evidence of benefit, the landscape of palliative care delivery hasn’t greatly changed. While the number of people who were referred to palliative care as in-patients increased from 54% in 2005-9 to 66% in 2018, the timing of the first contact with palliative care was later (median 25 to 22 days), meaning there was less time to access or experience the benefits available. Furthermore, the number of people who first accessed palliative care at their final hospital admission during which they died increased from 33 to 43%.
It seems that despite the mature body of evidence that supports early palliative integration, this knowledge is not being translated into practice. New service delivery approaches are required to facilitate the early integration of palliative care as a standard of high-quality care for people with cancer.
This work was supported by the Victorian Integrated Cancer Services, Australia.
References
- Philip J, Collins A, Warwyk O, Sundararajan V, Le B. Is the use of palliative care services increasing? A comparison of current versus historical palliative care access using health service datasets for patients with cancer. Palliat Med. 2022 Oct;36(9):1426-1431. doi: 10.1177/02692163221118205. Epub 2022 Aug 24.
Jennifer Philip
Professor of Palliative Medicine
The University of Melbourne and St Vincent’s Hospital