Inaugural Palliative Care Symposium Focuses on Improving Field partnership between medical oncologists and palliative care specialists and some of the financial and work challenges faced by US cancer survivors were among studies featured at the first Palliative Care in Oncology Symposium, which was held in Boston in October 2014. The meeting was sponsored by 4 leading medical specialty societies: the American Society of Clinical Oncology, the American Academy of Hospice and Palliative Medicine, the American Society for Radiation Oncology, and the Multinational Association of Supportive Care in Cancer. Here are 2 research highlights from the meeting.
Oncology/Palliative Care Partnership Improves Readmission Rates An evaluation of a pioneering “co-rounding” partnership between medical oncologists and palliative care specialists at Duke University Medical Center in Durham, North Carolina, showed improvements in both health system–related and patient-related outcomes in one of the studies presented.
The first year of the partnership in the hospital’s inpatient solid tumor oncology unit led to statistically significant decreases in the average length of hospital stay and in hospital readmission rates in comparison with a previous year that had no such partnership. The unit also experienced fewer intensive care unit transfers and a trend toward more hospice referrals. Lead author Richard Riedel, MD, medical director of the unit, believes that this model is the first example of palliative care physicians and medical oncologists working side by side every day in an inpatient oncology ward. Using the skill set of both specialists has enabled the unit to better manage symptoms, shorten hospital stays, and prevent readmissions, he says. At the same time, the partnership has fostered a better understanding among nurses and physicians of the role of palliative care. The partnership, initiated in 2011, includes formal meetings 3 times daily in which members of the team, including both the attending medical oncologist and the palliative care physician, discuss all the patients in the unit. Patients with a higher symptom burden are usually assigned to palliative care specialists. Support staff, including physician assistants and internal medicine house staff, round with both attending physicians.
In assessing the new partnership, researchers found that it decreased the average length of the in-hospital stay (4.17 vs 4.51 days) and led to a 15% relative reduction in 7-day readmission rates and a 23% relative reduction in 30-day readmission rates. In addition, physicians and nurses were all satisfied with the partnership. The researchers are planning future studies to assess longer term effects of the intervention on both patient and health-system outcomes and to evaluate patient satisfaction as well as potential cost savings.
Financial, Work Hardships High Among Survivors In another study by the University of California, Davis, results from a survey of nearly 1600 cancer survivors show a high prevalence among them of financial and work-related difficulties. Specifically, the survey found that: • 27% reported at least 1 financial problem, such as debt or bankruptcy. • 37% reported having to modify work plans, such as taking extended time off or delaying retirement. • Women, younger survivors, racial and ethnic minorities, and uninsured survivors were all disproportionately burdened by these challenges. • Those in active treatment reported a 120% higher rate of financial difficulties than survivors who were fewer than 5 years after treatment. Most prior studies have focused on a small subgroup of patients with cancer or examined medical expenditures versus the actual financial burdens that survivors experience. This study is the first to explore such burdens in a large, nationally representative group of cancer survivors according to the researchers. Lead study author Robin Whitney, RN, BSN, a cancer survivor and PhD student at the University of California, Davis, notes that she and colleagues found that many cancer survivors, particularly those who are younger and from underserved
populations, experience financial and work hardships even when they are insured and are years out from treatment. She adds that the findings point to the urgent need for screening and support for financial and work challenges among cancer survivors. DOI: 10.1002/cncr.29312
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Content in this section does not reflect any official policy or medical opinion of the American Cancer Society or of the publisher unless otherwise noted. © American Cancer Society, 2015.
Cancer
March 15, 2015
805
Copyright of Cancer (0008543X) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Oncology/Palliative Care Partnership Improves Readmission Rates An evaluation of a pioneering “co-rounding” partnership between medical oncologists and palliative care specialists at Duke University Medical Center in Durham, North Carolina, showed improvements in both health system–related and patient-related outcomes in one of the studies presented.
The first year of the partnership in the hospital’s inpatient solid tumor oncology unit led to statistically significant decreases in the average length of hospital stay and in hospital readmission rates in comparison with a previous year that had no such partnership. The unit also experienced fewer intensive care unit transfers and a trend toward more hospice referrals. Lead author Richard Riedel, MD, medical director of the unit, believes that this model is the first example of palliative care physicians and medical oncologists working side by side every day in an inpatient oncology ward. Using the skill set of both specialists has enabled the unit to better manage symptoms, shorten hospital stays, and prevent readmissions, he says. At the same time, the partnership has fostered a better understanding among nurses and physicians of the role of palliative care. The partnership, initiated in 2011, includes formal meetings 3 times daily in which members of the team, including both the attending medical oncologist and the palliative care physician, discuss all the patients in the unit. Patients with a higher symptom burden are usually assigned to palliative care specialists. Support staff, including physician assistants and internal medicine house staff, round with both attending physicians.
In assessing the new partnership, researchers found that it decreased the average length of the in-hospital stay (4.17 vs 4.51 days) and led to a 15% relative reduction in 7-day readmission rates and a 23% relative reduction in 30-day readmission rates. In addition, physicians and nurses were all satisfied with the partnership. The researchers are planning future studies to assess longer term effects of the intervention on both patient and health-system outcomes and to evaluate patient satisfaction as well as potential cost savings.
Financial, Work Hardships High Among Survivors In another study by the University of California, Davis, results from a survey of nearly 1600 cancer survivors show a high prevalence among them of financial and work-related difficulties. Specifically, the survey found that: • 27% reported at least 1 financial problem, such as debt or bankruptcy. • 37% reported having to modify work plans, such as taking extended time off or delaying retirement. • Women, younger survivors, racial and ethnic minorities, and uninsured survivors were all disproportionately burdened by these challenges. • Those in active treatment reported a 120% higher rate of financial difficulties than survivors who were fewer than 5 years after treatment. Most prior studies have focused on a small subgroup of patients with cancer or examined medical expenditures versus the actual financial burdens that survivors experience. This study is the first to explore such burdens in a large, nationally representative group of cancer survivors according to the researchers. Lead study author Robin Whitney, RN, BSN, a cancer survivor and PhD student at the University of California, Davis, notes that she and colleagues found that many cancer survivors, particularly those who are younger and from underserved
populations, experience financial and work hardships even when they are insured and are years out from treatment. She adds that the findings point to the urgent need for screening and support for financial and work challenges among cancer survivors. DOI: 10.1002/cncr.29312
© RIDO / FOTOLIA.COM, ERICSPHOTOGRAPHY / GETTYIMAGES.COM
A
Content in this section does not reflect any official policy or medical opinion of the American Cancer Society or of the publisher unless otherwise noted. © American Cancer Society, 2015.
Cancer
March 15, 2015
805
Copyright of Cancer (0008543X) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
