Streamlining oncology (Onc) and specialist palliative care (SPC) into integrated patient (pt) care is increasingly a gold standard of optimized cancer care. The ways that integrated Onc/SPC manifests in clinical practice may change over time. Little is known about factors that drive evolution in integrated care practices.
From a pt’s first appointment with outpatient SPC, all visits were chronologically color coded for Onc, SPC, and Neutral (e.g. emergency) or joint visits (Onc/SPC same day). Visual Graphic Analysis revealed 4 patterns of integration (Onc only; SPC only; CONCurrent: permanent exchange of Onc and SPC, ≥5 switches, joint visits; SEGmented: alternating periods of Onc or SPC, <4 switches), independent researchers approved reliability of patterns definitions. Data from 2006-2009 (presented 34-ESMO 2009) were compared with 2016-2017. Explanatory factors for patterns evolution were derived from multi-professional, consensual discussion reviewing descriptive statistics (e.g. impact of inpt admission on patterns, pattern stability over 3 months intervals, anticancer treatment administered by SPC, pt characteristics) and further explored in the data.
345 pts from 2006-09 and 64 from 2016 met eligibility criteria and were included. CONC occurred in 18% in 2006-09 and 45% in 2016 (Χ2 (1, N = 409) = 22.66, p < .001)], and 14% vs 50% remained in the CONC pattern comparing 3 months intervals. Elimination of inpt visits left 3/4 of patterns unchanged. A double-boarded Onc/SPC physician saw 94% of pts in the 2016 sample and prescribed systemic anticancer treatment in > 1/3 of these visits, 77% of these pts were in the CONC Pattern. Joint Onc/SPC visits were increasing over time, also (bi-)weekly alternating visits by Onc and SPC (double-boarded). Pts of CONC had complex and high needs for palliative interventions, were in phase I studies, or refused standard anticancer treatment, but accepted later.
Concurrent Onc/SPC is an increasing and consistent pattern, not explained by mere bed availability. Prescribing anticancer therapy by a double-boarded physician may foster integration. Further research may determine how CONC affects pt outcomes and the influence of pt and physicians’ characteristics.
Clinical trial identification
Legal entity responsible for the study
Cantonal Hospital St.Gallen.
Has not received any funding.
All authors have declared no conflicts of interest.