The Benefit of Marrying PROs With Coordinated Care in Advanced Cancer Patients

Fewer end-of-life hospitalizations, increased hospice care, and eventually reduced total costs per patient during the last 90 days of life—encouraging results presented at the 57^th annual meeting of the American Society for Radiation Oncology (ASTRO) held in San Antonio, Texas.

Researchers at the University of Virginia Health System developed a patient-centered integrated care program for advanced cancer patients that utilized patient-reported outcomes (PROs) to alter care delivery. Following a pilot that was completed in February 2013, the researchers began collecting PROs for all patients in October 2013. Patient reports on their emotional and physical performance was recorded in the electronic medical record. The hospital’s CARE Track palliative care program was kept abreast of changes to a patient’s status.

The 368 CARE Track patients included in the study were compared to 198 patients not enrolled in the study. The 368 patients had a total of 967 PRO surveys on record. Analysis of patient medical care showed that only about 48% of enrolled patients were hospitalized in the last 90 days of life compared with 64% of patients in the control cohort who were not monitored by palliative care specialists. Hospice care was also significantly higher among the CARE Track—enrolled patients than the control group (nearly 70% compared with 47%). The outcome was fewer hospital deaths for the enrolled group (8.4%) compared with the control group (38.5%), and ultimately a significant saving in total cost of more than $7000 per patient enrolled in the CARE Track program in the last 90 days of life.

The other aspect of the study was the use of palliative radiotherapy for pain control. Patients with painful bone metastases were administered higher doses (2 to 5 fractions of 5 Gy to 10 Gy each) of radiation therapy over shorter durations that resulted in quicker pain relief. The patients reported 80% to 90% partial or complete pain relief by 3 months and a significant improvement in quality of life. A consequent trial, currently accruing patients, will measure the effect of an even greater dose escalation (8 Gy to 15 Gy) that can be completed in a single sitting.

Highlighting the importance of patient-centered care, Paul W. Read, MD, PhD, lead author of the study and professor of radiation oncology at the University of Virginia Health System, said in a press release, “If we listen to our patients carefully, talk to them about their changing medical and emotional needs and develop rapid and coordinated treatment plans we can improve their quality of life and reduce their need for hospitalization for symptom management at the end of life.”