Background

Little is known about the number of hospitalized cancer patients with a limited life expectancy. Moreover, there is scarce information regarding involvement of specialist palliative care teams (PCT) among hospital inpatients.This study aimed to investigate how many patients with a probable limited life expectancy were hospitalized in Dutch hospitals on a given day, whether a PCT was involved or if involvement was considered desirable.

Methods

A flash mob study was conducted in Dutch hospitals on the 16th of April 2021. For all hospital inpatients, physicians and nurses independently answered the surprise question (SQ): “Would you be surprised if this patient died within the next 12 months?”. If the answer was ‘no’ they were asked to indicate if they estimated life expectancy to be less than 3 months and whether PCTs were involved. We here report a subgroup analysis for hospital inpatients with haematological and solid cancer.

Results

Forty-eight out of 68 hospitals in the Netherlands participated in this study (71%). Surveys were completed for 1693 patients with cancer. The SQ was negatively answered in 49% of patients by physicians and 47% by nurses, respectively. Agreement between physicians and nurses was moderate (κ=0.49). Life expectancy was estimated to be less than 3 months in 13.4% and 12.2% of patients by physicians and nurses, respectively (κ= 0.56). Treatment limitations were registered in 37.7% of all patients, increasing to 58.1% and 75.5% of patients with an estimated life expectancy of less than 12 months or less than 3 months, respectively. The PCT was involved in 6.3%of patients, and involvement was desirable in 4.9% according to physicians, increasing to 26.0% and 14.8% when life expectancy was estimated to be less than 3 months.

Conclusions

In almost half of the hospital inpatients with cancer, the SQ was answered negatively, suggesting a limited life expectancy and possible palliative care needs. PCTs were involved in only a small proportion of these patients, suggesting a possible lack of timely palliative care. Further studies should focus on exploration of palliative care needs of hospital inpatients, ways to improve identification of patients with a limited life expectancy for all healthcare providers and strategies to timely start palliative care.

Clinical trial identification

NL9184.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

Background

In Kazakhstan, about 34,000 patients were diagnosed with cancer and 14,000 patients died from oncological diseases in 2021. According to the Quality of Death Index, Kazakhstan ranks 50th out of 80 countries assessed. Currently, some form of inpatient end-of-life care in Kazakhstan is provided by only 9 hospices, several nursing homes, palliative care units, and mobile teams. In 2020, the total number of palliative care beds did not exceed 980 across the country, while around 135,000 patients need palliative care at any given time. The objective of this study is to assess the cost-effectiveness of hospice-based palliative care for terminal cancer patients compared to treatment in palliative units of cancer centers.

Methods

182 family caregivers have been recruited: 104 from hospices and 78 from cancer centers. Patients’ state of health and family caregivers’ burdens have been measured using Palliative Outcome Scale (POS) and Zarit Carer Burden Interview (ZBI) on the 14th day of inpatient palliative care. Direct, indirect treatment costs, and family caregivers’ out-of-pocket expenditures (OOPs) associated with the care, have been collected. The cost-effectiveness analysis was conducted by combining the mean cost difference with the data on outcome differences (POS and ZBI on the 14th day). Uncertainty around the cost-effectiveness estimates was explored by generating 10,000 resamples using bootstrapping and computing cost, and outcome differences for each and plotted on the cost-effectiveness plane.

Results

The mean difference in ECOG performance status between the two groups was not statistically significant at the time of admission (p=0,.061). After 14 days of treatment, patients’ mean quality of life was 2.4 points better (95% CI: 0.06 – 4.9) and family caregiver burden was 4.6 points better (95% CI: -0.26 - 9,.3) in the hospice group compared to the control. Mean treatment costs over 14 days were $31 lower for the hospice group (95% CI: $29 - $32). There was a significant correlation between the total cost of treatment and patients’ quality of life (r = 0,.58; p < 0.01).

Conclusions

This analysis suggests that hospice-based palliative care is cost-effective compared to the care provided in palliative units of cancer centers.

Editorial acknowledgement

TRANSLATE with x English.

Legal entity responsible for the study

Islam Salikhanov.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

Background

Though the positive impact of palliative care physicians and nurses on end of life medical outcomes is increasingly well-established, little is known about the impact of spiritual caregivers, psychologists, and social workers on desired end of life medical outcomes. In particular, on reduced use of aggressive care in the final two weeks of life, having more time after the last active oncological treatment and before death, and increased hospice use.

Methods

Prospective study of 180 cancer patients and their families, their interactions with social work, psychology, and spiritual care, and the above three treatment outcomes.

Results

The key psycho-social-spiritual interventions associated with reduced end of life aggressive care were having one or more spiritual care visits (adjusted odds ratio 2.02; p=0.04), having more quality visits with the psychologist (p=0.01), and speaking with someone about one's inner resources (AOR=2.25; p=0.03). The key interventions correlating with increased time after final treatment were a greater number of visits with the spiritual caregiver or the social worker (AOR=1.30; p<0.001), and speaking about the medical treatment (AOR=1.54; p<0.001) and about interpersonal relationships (AOR=2.28; p<0.001). Earlier palliative care conversations with the physician correlated with both these outcomes as well. A subjectively good-quality connection with the spiritual caregiver correlated with increased hospice use (AOR=10.00; p=0.01). Each profession contributed to these outcomes in distinct ways.

Conclusions

Ensuring provision of spiritual care, psychology, and social work to cancer patients at the end of life can help reduce futile aggressive measures, improve quality of life, and reduce costs.

Legal entity responsible for the study

The authors.

Funding

The Joint Distribution Committee – Eshel and the Government of Israel's Ministry of Health, as part of the National Program for Palliative Care.

Disclosure

All authors have declared no conflicts of interest.

Background

Effective interventions to improve prognosis in non-small-cell lung cancer (NSCLC) are urgently needed. We assessed the effect of the early integration of interdisciplinary palliative care for patients with NSCLC on the nutritional status, quality of life (QoL), psychological state and cancer pain.

Methods

In this randomised controlled trial, 120 newly diagnosed NSCLC patients were enrolled and randomly assigned (1:1) to the combined early palliative care (CEPC) group integrated with standard oncologic care or standard oncological care (SC) group. QoL and psychological state were assessed at baseline and at 24 weeks by Functional Assessment of Cancer Therapy-Lung (FACT-L) scale, the Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire-9 (PHQ-9), respectively. Cancer nutritional and pain status were assessed with the use of the Patient-Generated Subjective Global Assessment (PG-SGA) and Numerical Rating Scale (NRS), respectively. The primary outcome was the change in the quality of life, psychological state and nutritional status at 24 weeks. Analysis was by intention to treat.

Results

120 patients were enrolled: 60 in CEPC group (38 completed) and 60 in the SC group(32 completed). Patients in CEPC group had a better nutritional status [severe malnutrition: 11.67% (7/60); mild or moderate malnutrition: 61.67% (37/60); no malnutrition: 26.67% (16/60)] than SC group[severe malnutrition: 36.67% (22/60); mild or moderate malnutrition: 55.0% (33/60); no malnutrition: 8.3% (5/60)] (P=0.001). Furthermore, CEPC group had a better QoL than SC group (P<0.05). In addition, fewer patients in the CEPC group than in the SC group had depressive (P=0.005) symptoms. There was no significant difference in NRS score between CEPC group and SC group.

Conclusions

Among patients with non-small-cell lung cancer, early palliative care led to significant improvements in nutritional status, quality of life and psychological state.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

Background

Patients with advanced lung cancer often need intensive care unit (ICU) care, as result of its high morbidity and mortality. However, there is controversy regarding the benefit from intensive treatments in patients with lung cancer. We analyzed clinical outcomes of patients with lung cancer who had ever been treated with ICU care.

Methods

All patients >18 year of age with newly diagnosed lung cancer between 2008.1.1 ∼ 2010. 12.31 were extracted from the claims data from the Health insurance review and assessment service (HI-RA). (code C34.x of the International Classification of Diseases 10th revision) The claims data for extracted patients were followed by December 31, 2015. We analyzed clinical outcomes including mortality of admissions to ICU.

Results

After lung cancer diagnosis, 21.2% (n=36,318) of lung cancer patients were treated in ICU. 55.8% (n=16,083) of them were admitted to ICU for medical reasons. Lung cancer patients with ICU care were predominantly male (71.6% vs 64.2%) and older (66.1±10.7 vs 65.8±12.0) than those without ICU care. Patients with ICU care experienced more respiratory failure (56.5% vs. 8.4%) and more cardiopulmonary resuscitation (14.0% vs. 4.2%). Within 1 year of diagnosis, mortality was lower in patients with ICU care than those without ICU care at 180 days (30.6% vs 40.6%) and at 1 year (47.6% vs. 53.3%). However, patients with ICU care showed worse long-term mortality than those without ICU care at 2 years and 5 years.

Conclusions

Our study suggested ICU management might not be futile in all lung cancer patients. It need further classification of critically ill patients with lung cancer according to outcome predictors. The precise decision for ICU management could improve outcomes of these patients without prolonging a painful dying process.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

Background

High-Flow Nasal Cannula (HFNC) has shown benefits in patients with acute respiratory failure. However, efficacy and tolerability of HFNC in advanced cancer patients under palliative care setting has not been fully investigated.

Methods

Advanced cancer patients who had dyspnea at rest (numeric rating scale: NRS ≥ 3) and respiratory failure were enrolled. Patients were treated with HFNC for 5 days and patient-reported dyspnea was assessed using modified Borg scale and NRS. Primary endpoint was change of mean modified Borg scale at 24 hours. Key secondary endpoints consisted of change in modified Borg scale during study period and feasibility. Based on the hypothesis that change of HFNC will improve modified Borg scale from 1.5 to 2.5 (0.10 of one-sided α and power of 0.80), 21 patients are required (Trial Identifier, UMIN000035738).

Results

Between Feb 2019 and Feb 2022, 25 patients were enrolled and 21 were analyzed. Mean age was 72 (range, 48-92); male/female 17/4; ECOG PS 3/4 17/4. Twenty patients used inspired oxygen and mean fraction of inspired oxygen (FiO2) was 0.34 (range, 0.21-1.0). At baseline, mean modified Borg scale (dyspnea) was 5.2 (range, 2-10), and mean NRS (dyspnea) was 5.9 (range, 3-10). Median survival time was 19 days (range, 3-657). After starting HFNC, 90% (19 patients) could continue HFNC for 24 hours and 52% (11 patients) completed 5 days of HFNC. The change of mean modified Borg scale was 1.4 (80%CI: 0.8-1.9) at 24 hours, which did not reach the primary endpoint, while 52% (11 patients) showed 1.5 points improvement of modified Borg scale. Change of mean modified Borg scale at each timepoint was 1.3 (1 hour), 1.5 (2 hours), 1.4 (24 hours), 0.82 (day 3), 1.8 (day 4), and 2.3 (day 5), respectively. Within 1 hour, 42% (9 patients) showed 1.5 points improvement of modified Borg scale and such early responders were likely to maintain dyspnea improvement for 24 hours.

Conclusions

Although our study did not accomplish prespecified threshold, almost half had clinically meaningful improvement in dyspnea. HFNC can be a palliative treatment option in advanced cancer patients with dyspnea.

Clinical trial identification

UMIN000035738.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

H. Akamatsu: Financial Interests, Personal, Invited Speaker: AstraZeneca K.K., Boehringer Ingelheim Japan Inc., Bristol-Myers Squibb, Chugai Pharmaceutical Co. Ltd., Eli Lilly Japan K.K., MSD K.K., Novartis Pharma K.K., Ono Pharmaceutical Co. Ltd., Pfizer Inc, Taiho Pharmaceutical Co. Ltd; Financial Interests, Personal, Research Grant: AMGEN Inc, Chugai Pharmaceutical Co. Ltd., MSD K.K.. S. Teraoka: Financial Interests, Personal, Advisory Board: Pfizer R&D Japan G.K.; Financial Interests, Personal, Invited Speaker: AstraZeneca K.K., Chugai Pharmaceutical Co. Ltd. Eli Lilly Japan K.K., Novartis Pharma K.K., Taiho Pharmaceutical Co. Ltd., Boehringer Ingelheim Japan Inc., Eli Lilly Japan K.K., Ono Pharmaceutical Co. Ltd.. K. Furuta: Financial Interests, Personal, Invited Speaker: Nippon Boehringer Ingelheim Co. D. Fujimoto: Financial Interests, Personal, Research Grant: AstraZeneca KK, BoehringerIngelheim Japan Inc; Financial Interests, Personal, Invited Speaker: AstraZeneca KK, Ono Pharmaceutical Co Ltd Honoraria, Bristol-Myers Squibb Co Ltd, Taiho Pharmaceutical Co Ltd, Chugai Pharmaceutical Co Ltd, Merck Sharp & Dohme KK Honoraria, BoehringerIngelheim Japan Inc, Eli Lilly Japan KK, Novartis Pharma K.K, Kyowa Kirin Co. Ltd Honoraria, Janssen Pharmaceutical KK; Financial Interests, Personal, Advisory Board: AstraZeneca KK, Chugai Pharmaceutical Co Ltd. N. Tokudome: Financial Interests, Personal, Invited Speaker: Chugai Pharmaceutical Co., Ltd., Boehringer Ingelheim. Y. Ozawa: Financial Interests, Personal, Invited Speaker: AstraZeneca K.K., Chugai Pharmaceutical Co. Ltd., Taiho Pharmaceutical Co. Ltd., Novartis Pharma K.K., Nippon Kayaku, Msd K.K., Ono Pharmaceutical Co. Ltd., Takeda Pharmaceutical Co. Ltd. N. Yamamoto: Financial Interests, Personal, Invited Speaker: MSD K.K., Chugai Pharmaceutical CO., LTD., Ono Pharmaceutical Co., Ltd., AstraZeneca, Takeda Pharmaceutical CO., LTD., Eli Lilly Japan K.K., Novartis, Pfizer Inc., Janssen, Taiho, Daiichisankyo, Amgen Inc., Eisai Co., Ltd., Toppan Printing Co., Ltd., Boehringer-Ingelheim. All other authors have declared no conflicts of interest.

Background

Significant improvements in diagnostics and anticancer treatments have led to an increased incidence of brain metastases (BMs). Patients with BMs experience several symptoms such as headache, nausea, imbalance, seizures, cognitive impairment and fatigue, in addition to impaired quality of life (QoL) and everyday functioning. Research on patient perspectives on living with BMs is scarce. This longitudinal interview study investigates patient experiences with diagnosis and life with BMs. These data can inform health care providers how to best approach BM-patients and their needs.

Methods

Semi-structured interviews with 20 purposively sampled newly diagnosed BM-patients were conducted at baseline, 2 and 4 months in an ongoing prospective BM-study. The interview guide focused on patient experiences of: receiving the BM diagnosis, participation in treatment decision-making, everyday functioning, symptoms, worries and needs. Transcripts were analysed applying a qualitative longitudinal trajectory approach.

Results

were comprised in the following 4 themes that were applicable across the 3 time points: The Brain; an additional burden or more of the same? – A majority of the patients did not seem particularly concerned about the location of the metastatic disease. Trust – Patients have confidence in the treatment they receive and are satisfied with their care in spite of not being involved in treatment decisions. Still, some lack information about diagnosis, treatment, side effects and prognosis, and might have unanswered questions they do not openly address. Distancing - Instead of openly dwelling about their diagnosis or the future, patients actively try to live as usual. The new normal - Patients adapt to the situation and report living well, even when experiencing burdensome symptoms and substantial limitations in daily activities.

Conclusions

Life of BM-patients is considerably affected. Although patients cling to normalcy, impaired functioning, unmet information needs and inadequate symptom control may impair their QoL. Health care providers should actively explore each patient’s perspectives, needs and symptoms, and tailor individual treatment and care.

Clinical trial identification

NCT03346655.

Legal entity responsible for the study

Oslo University Hospital.

Funding

Norwegian Cancer Society South-Eastern Norway Regional Health Authority.

Disclosure

All authors have declared no conflicts of interest.

Background

Early palliative care improves symptoms and quality of life for patients (pts) with advanced cancer. At Veneto Institute of Oncology - IOV in Padua (Italy) a simultaneous care outpatient clinic (SCOC) has been active since 2014, in which pts with advanced-stage disease are evaluated by an oncologist with palliative care team. Pts have been referred to the SCOC through a referral form, scored to prioritize pts’ access, since 2018. We prospectively assessed SCOC pts’ characteristics and SCOC outcomes through the internal procedure indicators.

Methods

Pts referred to SCOC by IOV Oncology Unit 1 physicians were eligible. Data were retrieved from the SCOC prospectively maintained database.

Results

Eligible pts were 753. Median age was 68 years; 73.6% pts had gastrointestinal cancer, 13.7% had urological cancer and 12.7% had other types of cancer. Disease stage was metastatic in 90.9% of pts. Predominant symptoms were psychological disorders (69.4%), appetite loss (67.5%) and pain (65.9%). Full awareness of cancer diagnosis was detected in 95.3% of pts, of whom 58.5% had also a full awareness of prognosis. Median survival from SCOC visit was 7.3 months. The proportion of pts with survival <6 months increased during the years from 40.3% in 2018, to 65.9% in 2021 (p<0.0001). Survival estimates provided by the oncologist in the referral form was significantly different from the actual survival. Psychological intervention was deemed required and undertaken in 34.6% of pts and nutritional support in 37.9% of pts. Based on ESAS detected needs, activation of palliative care services was undertaken for 77.7% of pts. After SCOC visit, 22.6% pts had unplanned emergency room admissions. Out of 357 pts whose place of death is known, 69.2% died in a proper location (home, hospice and residential care). The indicator’s threshold was reached for 9 out of 11 parameters requested by procedure.

Conclusions

This study confirms the importance of close collaboration between oncologists and palliative care team to respond to all cancer pts’ needs. The introduction of a procedure with indicators allowed us to evaluate the performance of the team so as to improve it.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

Background

Preventing overtreatment is a cornerstone of palliative care that aims to reduce treatment (tx) burden especially for cancer pts. ARTs are perceived as being better tolerated and with decreased tx burden compared to traditional chemotherapies. Despite this view, there is little research supporting the use of ART or describing EOL outcomes in mPC pts with reduced PS (ECOG >= 2).

Methods

We performed a retrospective study of 165 pts with mPC who received ART between 2010 and 2021 at our institution. We assessed each record for demographic and clinical information, ART course, and survival and EOL outcomes. Our primary aim was to compare overall survival (OS) between the groups and our secondary aim was to describe EOL outcomes. Fischer’s Exact Tests were used to compare baseline characteristics. Cox regression was used to compare OS for pts with ECOG >= 2 at the start of tx with those who had an ECOG of 0 or 1. Descriptive analyses were performed to assess EOL outcomes.

Results

Median age at ART start was 70.0 years (range 42.0 – 70.0). 10.3% of pts had a ECOG >= 2 and 13.9% were post-chemo. Median OS was 8.8 months in the ECOG >= 2 group and 49.4 in the < 2 group. (HR: 4.58 [2.49 – 8.45] p-value < 0.001). Variables significant (p-value <= .2) on univariate survival analysis included charlson comorbidity index, bone metastases, radical prostatectomy, hospitalization, and ADT during tx. On multivariate survival analysis adjusted for these possible confounders, ECOG >=2 remained significantly associated with OS (HR: 1.72 [1.28 – 2.31] p-value <.001). Relevant EOL Outcomes are reported in table below. Table: 1274P

Conclusions

Pts with mPC and decreased PS experienced shorter OS compared to those with higher PS . Moreover close to a majority of pts died in the hospital with a greater percentage among those with ECOG >=2. These findings highlight the need for improved shared decision-making in ART tx and further research exploring the association between PS and EOL care.

Legal entity responsible for the study

The Authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

Background

In advanced and incurable cancer disease, chemotherapy may be recommended if it improves the quality of life, even if it does not increase survival. However, in an end-of-life setting, the use of chemotherapy is controversial, with less clear indications and more individualized decisions. This study aimed to evaluate patients who received chemotherapy within the last three months of life, an indicator of the quality of care provided.

Methods

We analyzed data from patients receiving chemotherapy in the last three months of life and who died from January 2018 to December 2020, in our Oncology Department.

Results

From January 2018 to December 2020, 7425 new cases of solid neoplasms were registered, of which 9% (n=696) died in the same period, despite the treatments performed. It was found that 391 received chemotherapy treatments in the last 3 months of life. Of these, 65% (n=255) were male, with a mean age of 63 years and the majority (81%, n=317) had an ECOG performance status (PS) of 0-1. Regarding oncological disease, the most frequent diagnoses were lung cancer in 33% of cases (n=128), gastric cancer in 14% (n=53) and colorectal cancer in 12% of cases (n=47). As for staging, 71% (n=276) of patients had metastatic disease. Most patients (66%, n=258) underwent chemotherapy with doublets, in a first-line setting. A more detailed analysis revealed that 28% of patients (n=193) underwent treatment in the last month and 6% (n=42) in the last week of life.Of these 193 patients, 53% died from disease progression and 20% due to treatment-related complications such as febrile neutropenia. Most deaths occurred in the hospital (79%, n=153). In the last month of life, patients had an average of two episodes of admission to the emergency department and one episode of hospitalization. Best supportive care was decided for 21% of patients (n=40) and of these, only 13% (n=25) were referred to the palliative care unit.

Conclusions

This work puts into figures the reality of an Oncology Centre, revealing the investment made in fighting the disease and providing greater longevity to patients, with quality of life.

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

Background

New treatment strategies are approved for advanced lung cancer. So far, its impact on the duration of palliative care (PC) remains unknown. The objective of this study is to describe the evolution of palliative care duration over the last decade, and to identify predictive factors for longer PC duration.

Methods

A retrospective study in a single center over a 10-year period (2011-2020) was conducted. Palliative care duration (PCD) was determined in all patients with confirmed lung cancer attended in a PC unit. A multiple regression analysis was performed to predict longer PCD based on eight clinical factors, including Eastern Cooperative Oncology Group (ECOG) performance status, oncological outcomes and previous treatments received.

Results

Median PCD increased from 18 days (2011) to 48 days (2020) (p<0.01). Percentage of patients with longer follow-up (≥6 months) increased from 7.8% (2011) to 21.6% (2020) (p<0.01). Proportion of patients with better performance status (ECOG PS 0-2) at the moment of first PC visit increased from 15.6% (2011) to 29.4% (2020) (p<0.01). Five analyzed factors were predictors for longer PCD (ECOG PS 0-2, first visit in an outpatient setting, previous treatment based on immunotherapy/targeted therapy, time to PC from diagnosis ≥6 months, overall survival ≥6 months). No differences in PCD were observed based on age, gender, or previous treatment based on chemotherapy.

Conclusions

An increase in PCD is observed over the last decade, as well as an increase in the percentage of patients with longer follow-up and better performance status. Previous treatment based on immunotherapy/targeted therapy, oncological outcomes and ECOG PS could constitute predictive factors for longer PCD.

Legal entity responsible for the study

Hospital de la Santa Creu i Sant Pau.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.

Background

Patients with Glioblastoma Multiforme (GBM) have a prognosis of 16-21 months and high care needs due to progressive neurological deficits, cognitive impairment, and behavioural change. They often do not express the usual symptoms generally associated with advanced incurable cancer. They therefore represent a challenge to the classic palliative care assessment of needs. We aim to review patients with GBM who were referred to a hospital specialist palliative care (HSPC) service in a quaternary centre to inform service development.

Methods

Data on diagnosis and patient care was extracted from the HSPC database and the Neuro-Oncology Multidisciplinary Meeting (MDM) in 2021.

Results

In 2021 165 patients were discussed at the MDM. 62% opted to have systemic therapy locally. The HSPC reviewed 31 patients with GBM. The median age was 57 years. 42% had a resection and 39% had biopsy only. 71% had both chemotherapy and radiotherapy, 3.2% and 6.5% surgery and radiotherapy only respectively. 19.3% had no disease targeted treatment 42% of patients were transferred to hospice after HSPC review. A further 25.8% had a HSPC facilitated discharge to home or nursing home (9.7 %). 19.3% died in hospital. Median number of days from MDM to death was 288 (range 7 - 2032). Median number of days from SPC referral to death was 26 (range 1 – 243). Table: 1277P

Reported symptom burden at time of referral to HSPC

Conclusions

The high rate of functional and cognitive impairment shown in this patient cohort reflects published literature. Despite anticipated trajectory of decline, patients were referred late to HSPC and referral numbers are low compared to numbers discussed at MDT. Most patients in this cohort required hospice admission at end of life reflecting the complexity of their care. Earlier referral to HSPC prior to cognitive decline may facilitate more meaningful patient engagement with HSPC and allow opportunities for family support. Low HSPC staffing levels may be an unrecognised cause of the delayed referrals, and may negatively impact patients' experience of their final months.

Legal entity responsible for the study

Beaumont Hospital.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.