The Impact of Palliative Care Consultation on Overall Survival and Aggressive Care at End-of-Life in Unresectable Pancreatic Cancer
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Background: Early Palliative Care (PC) consultation has been associated with improved overall survival (OS) and less aggressive care at end-of-life in a number of malignancies. For patients with unresectable pancreatic cancer (UPC), aggressive and resource-intensive treatment at the end-of-life can be costly, but not necessarily of better quality. Methods: This retrospective cohort study examines the potential impact of early PC consultation on indicators of aggressive care at end-of-life and OS in all patients diagnosed with UPC in Nova Scotia between January 1, 2010 and December 31, 2015. Results: In total, 365 patients were identified for inclusion in our study. Patients seen by PC late in the trajectory of their disease (>8 weeks following diagnosis) had better OS than those receiving either early PC (< 8 weeks following diagnosis) or no PC (median OS 191.0 days vs 64.0 days and 23.5 days, p < 0.001). These findings were further supported by analysis through a multivariable adjusted statistical model, which indicated that late PC intervention was associated with 62 times decreased risk of death (Hazard Ratio = 0.38, p < 0.001) while early PC intervention was not (Hazard Ratio = 0.92, p = 0.610). PC consultation, either early or late, was associated with decreased odds of experiencing one or more indicators of aggressive care at end-of-life, as indicated by multivariable adjusted logistic regression (Odds Ratio = 0.18, 95% CI 0.08 - 0.39, p < 0.001; Odds Ratio = 0.20, 95% CI 0.08 - 0.47, p < 0.001). Conclusions: Regardless of timing, PC consultation was associated with decreased odds of experiencing an indicator of aggressive care at end-of-life. However, early PC consultation was not associated with decreased risk of death.