Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jan 1;126(9):2013-2023.
doi: 10.1002/cncr.32738. Epub 2020 Feb 12.

State of palliative care services at US cancer centers: An updated national survey

David Hui  1 , Allison De La Rosa  1 , Joseph Chen  1 , Seyedeh Dibaj  2 , Marvin Delgado Guay  1 , Yvonne Heung  1 , Diane Liu  2 , Eduardo Bruera  1
Affiliations

State of palliative care services at US cancer centers: An updated national survey

David Hui et al. Cancer. .

Abstract

Background: This study examined the changes in outpatient palliative care services at US cancer centers over the past decade.

Methods: Between April and August 2018, all National Cancer Institute (NCI)-designated cancer centers and a random sample of 1252 non-NCI-designated cancer centers were surveyed. Two surveys used previously in a 2009 national study were sent to each institution: a 22-question cancer center executive survey regarding palliative care infrastructure and attitudes toward palliative care and an 82-question palliative care program leader survey regarding detailed palliative care structures and processes. Survey findings from 2018 were compared with 2009 data from 101 cancer center executives and 96 palliative care program leaders.

Results: The overall response rate was 69% (140 of 203) for the cancer center executive survey and 75% (123 of 164) for the palliative care program leader survey. Among NCI-designated cancer centers, a significant increase in outpatient palliative care clinics was observed between 2009 and 2018 (59% vs 95%; odds ratio, 12.3; 95% confidence interval, 3.2-48.2; P < .001) with no significant changes in inpatient consultation teams (92% vs 90%; P = .71), palliative care units (PCUs; 26% vs 40%; P = .17), or institution-operated hospices (31% vs 18%; P = .14). Among non-NCI-designated cancer centers, there was no significant increase in outpatient palliative care clinics (22% vs 40%; P = .07), inpatient consultation teams (56% vs 68%; P = .27), PCUs (20% vs 18%; P = .76), or institution-operated hospices (42% vs 23%; P = .05). The median interval from outpatient palliative care referral to death increased significantly, particularly for NCI-designated cancer centers (90 vs 180 days; P = 0.01).

Conclusions: Despite significant growth in outpatient palliative care clinics, there remain opportunities for improvement in the structures and processes of palliative care programs.

Keywords: health services; hospital outpatient clinics; neoplasms; palliative care; surveys and questionnaires.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: The authors declare no conflict of interest. The funding organizations had no role in the design or conduct of the study; in collection, management, analysis, or interpretation of the data; or in preparation, review, or approval of the manuscript.

Figures

Figure 1.
Figure 1.. Study Design: Sampling Strategy and Analysis Plan.
(A) In 2009, we surveyed all 71 National Cancer Institute (NCI)-designated cancer centers and a random sample of 71 non-NCI designated cancer centers. In 2018, some cancer centers had changed designation or no longer open and some centers newly acquired the Commission of Cancer or NCI-designation. Thus, we surveyed all 70 previously surveyed NCI-designated cancer centers in 2009 (NCI previous cohort) and all existing 62 NCI-designated cancer centers in 2018 (NCI current cohort). We also surveyed all 66 previously surveyed non-NCI-designated cancer centers in 2009 (non-NCI previous cohort) and a new sample of 60 non-NCI-designated cancer centers in 2018 (non-NCI current cohort). For NCI-current cohort, because there were only a limited number of NCI-designated cancer centers, we had to survey all of them and could not examine a new sample as in the case for non-NCI current cohort. (B) In main analysis, we compared 2009 cohorts to 2018 current cohorts. In secondary analysis, we compared 2009 cohorts to 2018 previous cohorts.
Figure 2.
Figure 2.. Changes in the Availability of Palliative Care Clinical Programs between 2009 and 2018.
Cancer center executives reported that there was a significant increase in the availability of outpatient clinics, although the other services including inpatient consultation teams, palliative care units and institutional-run hospices remained stagnant.
See this image and copyright information in PMC

Comment in

References

    1. Whelan TJ, Mohide EA, Willan AR, Arnold A, Tew M, Sellick S, et al. The supportive care needs of newly diagnosed cancer patients attending a regional cancer center. Cancer 1997;80(8):1518–24. - PubMed
    1. Hui D, Bruera E. Models of Palliative Care Delivery for Cancer Patients. J Clin Oncol 2019. (in press). - PMC - PubMed
    1. Bischoff K, Yang E, Kojimoto G, Shepard Lopez N, Holland S, Calton B, et al. What We Do: Key Activities of an Outpatient Palliative Care Team at an Academic Cancer Center. J Palliat Med 2018;21(7):999–1004. - PubMed
    1. Hui D, Elsayem A, De la Cruz M, Berger A, Zhukovsky DS, Palla S, et al. Availability and integration of palliative care at US cancer centers. JAMA 2010;303(11):1054–61. - PMC - PubMed
    1. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010;363(8):733–42. - PubMed

Publication types