Availability and integration of palliative care at US cancer centers

Abstract

Context: The current state of palliative care in cancer centers is not known.

Objectives: To determine the availability and degree of integration of palliative care services and to compare between National Cancer Institute (NCI) and non-NCI cancer centers in the United States.

Design, setting, and participants: A survey of 71 NCI-designated cancer centers and a random sample of 71 non-NCI cancer centers of both executives and palliative care clinical program leaders, where applicable, regarding their palliative care services between June and October 2009. Survey questions were generated after a comprehensive literature search, review of guidelines from the National Quality Forum, and discussions among 7 physicians with research interest in palliative oncology. Executives were also asked about their attitudes toward palliative care.

Main outcome measure: Availability of palliative care services in the cancer center, defined as the presence of at least 1 palliative care physician.

Results: A total of 142 and 120 surveys were sent to executives and program leaders, with response rates of 71% and 82%, respectively. National Cancer Institute cancer centers were significantly more likely to have a palliative care program (50/51 [98%] vs 39/50 [78%]; P = .002), at least 1 palliative care physician (46/50 [92%] vs 28/38 [74%]; P = .04), an inpatient palliative care consultation team (47/51 [92%] vs 28/50 [56%]; P < .001), and an outpatient palliative care clinic (30/51 [59%] vs 11/50 [22%]; P < .001). Few centers had dedicated palliative care beds (23/101 [23%]) or an institution-operated hospice (37/101 [37%]). The median (interquartile range) reported durations from referral to death were 7 (4-16), 7 (5-10), and 90 (30-120) days for inpatient consultation teams, inpatient units, and outpatient clinics, respectively. Research programs, palliative care fellowships, and mandatory rotations for oncology fellows were uncommon. Executives were supportive of stronger integration and increasing palliative care resources.

Conclusion: Most cancer centers reported a palliative care program, although the scope of services and the degree of integration varied widely.

Figure 1. Perceived Barriers to Palliative Care Access According to Cancer Center Executives

Perceived barriers to palliative care access based on the question “Irrespective of whether palliative care is offered at your institution, what in your opinion, are some of the potential barriers to palliative care access for your institution? (check all that apply)”. All 51 NCI and all 50 non-NCI executives who responded to the survey completed this question. *P<0.05