Current patterns of care: Referral to palliative care for patients with metastatic gynecologic cancer.

Abstract

12089 Background: Multiple professional cancer organizations have clinical guidelines that recommend that patients with advanced cancers be referred to palliative care early in the disease course, typically within eight weeks of diagnosis (1). The extent to which these guidelines are adhered to, however, remains uncertain, particularly for patients with metastatic gynecologic cancers (MGC). We sought to characterize our current institutional patterns of referral to palliative care for these MGC patients. Methods: We conducted a retrospective chart review of gynecologic oncology patients treated at our institution between January 2022 and January 2024. We included adult, female patients with a diagnosis of FIGO stage IVB MGC, or cancer that has spread distantly. Patients with primary endometrial, cervical, ovarian, vaginal, or vulvar cancer were included. We excluded patients with less advanced disease or metastatic cancer from a non-gynecologic primary site. Data from the electronic health records of these patients were analyzed to determine key dates, including the diagnosis of stage IVB MGC, referral to palliative care, the first palliative care visit, and subsequent follow-up visits. Descriptive statistics were used to summarize the results. Results: Of the 549 patients included in the analysis, 152 (27.7%) had MGC. Within this subgroup, 76 patients (50%) were referred to palliative care. Of those referred, 65.8% (N = 50) were referred to palliative care either before or within 8 weeks of metastatic diagnosis. Referrals were made in both inpatient (47.4%, N = 36) and outpatient (52.6%, N = 40) settings. Following referral, 84.2% of patients (N = 64) had a consultation with a palliative care provider. However, less than half of these patients (48.4%, N = 31) continued outpatient follow-up with palliative care. When stratified by referral setting, 57.5% of patients (N = 23) referred in the outpatient setting continued follow-up care, compared to only 27.8% of those (N = 10) referred in the inpatient setting. Conclusions: Despite guidelines recommending early initiation of palliative care for all patients with advanced cancer, many patients with MGC either never receive a referral or experience considerable delays between metastatic diagnosis and palliative care consultation. In many cases, referrals are made only when patients are already hospitalized due to their cancer. Furthermore, we found that a substantial number of patients do not continue outpatient palliative care follow-up after their initial referral, with a more notable decline in continuity of care when the referral is made during an inpatient hospitalization. References: 1. Justin J. Sanders et al. , Palliative Care for Patients With Cancer: ASCO Guideline Update. JCO 42, 2336-2357(2024). DOI: 10.1200/JCO.24.00542 .