Chemotherapy prescription appropriateness in end-of-life cancer care: impact of referral to the palliative care specialist at the Cancer Institute of Romagna (IRST)–IRCCS

Abstract

The expansion of therapeutic possibilities for late-stage cancer patients and the increasing availability of new chemotherapeutic agents with a good toxicity profile can lead to aggressive and potentially inappropriate prescribing behavior, lacking detailed guidelines on this topic. Several studies have shown that the early introduction of palliative care results in significant improvements in the quality of life. A retrospective observational study was carried out at the Cancer Institute of Romagna (IRST IRCCS) to investigate the involvement of the palliativist in the patient’s therapeutic path, the timing of the oncologist’s request for an intervention from the palliativist and the impact of the community Palliative Care Unit on current clinical practice. Out of 1,250 consecutive patients receiving chemotherapy during the study period, a heterogeneous frequency in the request for palliative care intervention was observed in the different disease groups, with a progressive increase in the number consultations registered in all groups as the disease progressed. In a subgroup of patients treated at IRST who died in 2010, only 8 % who had contact with the Palliative Care Unit received the last therapeutic cycle in the final 15 days of life, and only 14 % received a new therapeutic line <30 days before death. The present study confirms that the integration of oncology and palliative care models leads to a more appropriate management of end-of-life patients. Our results could represent a natural background for further studies aimed at comparing normal clinical practice and early palliative care models.