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Specialist palliative care (SPC) in haematological malignancy: Establishing practices in a UK tertiary cancer centre (TCC)
abstracts
Annals of Oncology
Table: 1611P
Deaths in year ending 31/3/19 Documented referrals to SPC Time from Diagnosis to death Time from SPC referral to death For Tertiary Centre in-patient deaths only: Number of TCC in-patient deaths Chemotherapy in last 30 days Blood transfusion in last 30 days Platelets in last 30 days TPN in last 30 days Time from DNAR record to death
108 72/108 0 – 23 years 0 – 10 years
3 years 6 days
43 25/43 38/43 34/43 11/43 0 – 30 days
2 days pre death 3 days pre death 4 days pre death 3 days pre death
Conclusions: Haematological intervention remains frequent up until death but SPC involvement is relatively delayed. Later SPC input is expected to limit effective relationship building and advance care planning and the data shows differences in place of death for those with and without SPC referral. Results suggest an opportunity to support patient-centred care through the development of an integrated service with early SPC accessibility and a consultative survey is underway to ascertain how this might best be achieved. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
1611P
Specialist palliative care (SPC) in haematological malignancy: Establishing practices in a UK tertiary cancer centre (TCC)
E. Kedgley1, M. Nanda Kumar1, P. Sriskandarajah2, S. Bird3, M. Ethell3, J.M. Droney4, A. Halley1 1 Symptom Control & Palliative Care Team, Royal Marsden Hospital, London, UK, 2 Haemato-Oncology Department, The Institute of Cancer Research, Sutton, UK, 3 Haematology, Royal Marsden Hospital, London, UK, 4Symptom Control and Pallative Care Team, Royal Marsden Hospital NHS Foundation Trust, London, UK Background: International consensus supports early integration of SPC in oncological disease. Haematological malignancies differ in nature from solid site tumours. Remitting and relapsing trajectories, late salvage treatments, and divergent outcomes make for difficult prognostication and traditional markers of ‘good’ end of life care may not translate well to this group. However, disease is often incurable and physical and psychological symptom burden high, making SPC input essential. The authors propose an integrated care model to achieve this, utilising predefined triggers to identify unmet need and to guide SPC involvement from time of diagnosis. Such a service, “Triggers”, has been successfully developed for other cancer groups at the TCC. Through improved understanding of current practices we plan to tailor this service to meet the unique needs of the haematology patient group. Methods: A retrospective audit of electronic records was completed for patients dying of haematology malignancy in the 12 months to 31/3/18. Data relating to SPC referral, DNAR documentation, active interventions, place of death and diagnosis sub-type was collected. Results: Of 108 patients identified, 67 died in hospitals, including 43 at the TCC. Of 26 deaths within 30 days of discharge from the TCC, 100% of those with a previous SPC referral (16) died in the community while 80% of those without (10) died in a local hospital.
Volume 30 | Supplement 5 | October 2019
doi:10.1093/annonc/mdz261 | v665
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz261.013/5576517 by Institue for Cellular and Intracellular Symbiosis UB RAS user on 26 October 2019
Totals / Range Median
Annals of Oncology
Table: 1611P
Deaths in year ending 31/3/19 Documented referrals to SPC Time from Diagnosis to death Time from SPC referral to death For Tertiary Centre in-patient deaths only: Number of TCC in-patient deaths Chemotherapy in last 30 days Blood transfusion in last 30 days Platelets in last 30 days TPN in last 30 days Time from DNAR record to death
108 72/108 0 – 23 years 0 – 10 years
3 years 6 days
43 25/43 38/43 34/43 11/43 0 – 30 days
2 days pre death 3 days pre death 4 days pre death 3 days pre death
Conclusions: Haematological intervention remains frequent up until death but SPC involvement is relatively delayed. Later SPC input is expected to limit effective relationship building and advance care planning and the data shows differences in place of death for those with and without SPC referral. Results suggest an opportunity to support patient-centred care through the development of an integrated service with early SPC accessibility and a consultative survey is underway to ascertain how this might best be achieved. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
1611P
Specialist palliative care (SPC) in haematological malignancy: Establishing practices in a UK tertiary cancer centre (TCC)
E. Kedgley1, M. Nanda Kumar1, P. Sriskandarajah2, S. Bird3, M. Ethell3, J.M. Droney4, A. Halley1 1 Symptom Control & Palliative Care Team, Royal Marsden Hospital, London, UK, 2 Haemato-Oncology Department, The Institute of Cancer Research, Sutton, UK, 3 Haematology, Royal Marsden Hospital, London, UK, 4Symptom Control and Pallative Care Team, Royal Marsden Hospital NHS Foundation Trust, London, UK Background: International consensus supports early integration of SPC in oncological disease. Haematological malignancies differ in nature from solid site tumours. Remitting and relapsing trajectories, late salvage treatments, and divergent outcomes make for difficult prognostication and traditional markers of ‘good’ end of life care may not translate well to this group. However, disease is often incurable and physical and psychological symptom burden high, making SPC input essential. The authors propose an integrated care model to achieve this, utilising predefined triggers to identify unmet need and to guide SPC involvement from time of diagnosis. Such a service, “Triggers”, has been successfully developed for other cancer groups at the TCC. Through improved understanding of current practices we plan to tailor this service to meet the unique needs of the haematology patient group. Methods: A retrospective audit of electronic records was completed for patients dying of haematology malignancy in the 12 months to 31/3/18. Data relating to SPC referral, DNAR documentation, active interventions, place of death and diagnosis sub-type was collected. Results: Of 108 patients identified, 67 died in hospitals, including 43 at the TCC. Of 26 deaths within 30 days of discharge from the TCC, 100% of those with a previous SPC referral (16) died in the community while 80% of those without (10) died in a local hospital.
Volume 30 | Supplement 5 | October 2019
doi:10.1093/annonc/mdz261 | v665
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz261.013/5576517 by Institue for Cellular and Intracellular Symbiosis UB RAS user on 26 October 2019
Totals / Range Median