Specialists’ Perspective on Palliative Care for Patients With Advanced Cancer

Survey of palliative care specialists revealed mixed responses regarding their comfort level in caring for patients with advanced cancer undergoing active treatment. The findings from this study were reported in Supportive Care in Cancer.

Although there is a strong body of evidence supporting the benefits of early palliative care for patients with advanced cancer, referral to a palliative care specialist typically occurs late in the course of the patient’s disease. The main aim of this study was to assess the attitudes and practices of physician specialists in palliative care regarding early introduction of palliative care in the oncology setting.

In this study, a survey was sent to a cohort of physicians who provide palliative care in Canada as identified by the Canadian Society of Palliative Care Physicians. In addition to demographic questions, the survey queried participants regarding their opinions on early referral to palliative care, as well as their resources for practicing palliative care, and whether the term palliative care should be changed to supportive care.

Of the 746 physicians who received an invitation, 531 (71%) agreed to participate in the study, 48.6% of whom were identified as physicians who received referrals to provide palliative care. Of the palliative care specialists, approximately one-half were female, the majority (58.7%) were between ages 40 and 59 years, more than 90% practiced in an urban setting, approximately three-quarters had trained in family medicine, 82.4% identified as being members of a palliative care team, and 84.4% identified patients with cancer as making up more than 50% of their palliative care patients.

Although the majority of survey respondents (more than 90%) supported the provision of early palliative care, only 20% reported that the average survival time of patients referred to them for palliative care was more than 6 months. Furthermore, although acceptance rates for patients with an estimated life expectancy of 6 to 12 months, who are receiving IV chemotherapy, or have full resuscitation status were high (approximately 90% or more) in palliative care outpatient clinic/inpatient consultation services and home palliative care practice settings, acceptance rates for these groups were only 62.4%, 42.9%, and 45.9%, respectively, in the setting of a palliative care unit.

In addition, only 4% and 6% of respondents agreed that patients should stop chemotherapy and transfusions, respectively, prior to referral to palliative care; only 66% agreed that they were comfortable caring for a patient with a full resuscitation status. Interestingly, 18% of respondents preferred a model whereby the referring physician hands over all care to the palliative care specialist upon referral.

Regarding patient-specific factors, female sex and a post-graduate degree were associated with referral for early palliative care.

Only 21% of palliative care specialist respondents were in support of changing the name of palliative care to supportive care, although 60% agreed that patients have negative perceptions of the former term.

The study authors stated that “a true integration of palliative care and oncology will require expansion and adequate resourcing of outpatient palliative care programs in cancer centers as well as better engagement and improved education of primary care providers in oncology palliative care.”

References Sorensen A, Wentlandt K, Le LW, et al. Practices and opinions of specialized palliative care physicians regarding early palliative care in oncology [published online June 4, 2019]. Support Care Cancer. doi: 10.1007/s00520-019-04876-0