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. 2020 Sep;5(5):e000905.
doi: 10.1136/esmoopen-2020-000905.

Retrospective analysis of the prevalence of specialised palliative care services for patients with metastatic breast cancer

Eva Maria Jäger  1 , Martin Filipits  2 , Anna Glechner  3 , Elisabeth Zwickl-Traxler  4 , Gabriele Schmoranzer  4 , Martin Pecherstorfer  4 , Gudrun Kreye  5
Affiliations

Retrospective analysis of the prevalence of specialised palliative care services for patients with metastatic breast cancer

Eva Maria Jäger et al. ESMO Open. 2020 Sep.

Abstract

Background: Patients with metastatic breast cancer (MBC) have a considerable symptom burden and may require extensive care for a long period of time. Palliative care (PC) has the potential to improve their quality of care and reduce their use of medical services. However, the role of specialised PC (SPC) in patients with MBC remains unclear.

Patients and methods: We performed a retrospective analysis of the medical records of patients diagnosed with breast cancer (BC) from 2008 to 2018 at an university-based referral centre to examine the extent of early and late integration of SPC services for patients with MBC. A descriptive analysis of the patients was also established.

Results: In all, 932 patients were diagnosed with BC from 2008 to 2018; 225 of these patients had or developed metastases related to their BC. In addition, 132 patients received SPC (58.7%) and 93 patients did not receive SPC (41.3%). The median probability of overall survival (OS) for patients who did not receive SPC services was 3.6 years (95% CI 2.0 to 5.1) and 1.8 years (95% CI 1.3 to 2.3) (p<0.0001) for patients who did receive SPC. In multivariate analysis, referral to SPC services was independently associated with OS (HR 1.60, 95% CI 1.16 to 2.22, p=0.004).

Conclusion: Patients who received SPC lived significantly shorter amounts of time than patients not referred for SPC services at our hospital. We concluded that the referral to SPC services was often too late and should be implemented earlier in the course of the disease. We suggest that patients with MBC should participate in a consultation by a SPC team ≤60 days after the start of systemic palliative anticancer therapy in addition to endocrine treatment. Larger prospective studies are needed to evaluate the benefit of the early integration of SPC services for patients with MBC.

Keywords: metastatic breast cancer; palliative care; specialized palliative care.

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Conflict of interest statement

Competing interests: Martin Filipits has received honoraria for advisory boards from AstraZeneca, Bayer, Biomedica, Bio-Rad, Boehringer Ingelheim, Myriad Genetics Inc, Pfizer and Roche. All other authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart for patient selection. DCIS, ductal carcinoma in situ; ICD, International Statistical Classification of Diseases and Related Health Problems; SPC, specialised palliative care.
Figure 2
Figure 2
Overall survival related to the prevalence of specialised palliative care services (yes/no) for breast cancer patients with metastases related to breast cancer (n=225).
Figure 3
Figure 3
Overall survival related to the referral indication for breast cancer patients with metastases related to breast cancer (n=225).
See this image and copyright information in PMC

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