Abstract
Dear Editor:
Recently, Tangeman et al. 1 demonstrated that inpatient palliative care (IPC) consultation reduces hospitalization costs. We believe this is a very important finding, as due to increased survival of the general population and higher chances of having cancer together with the development of new expensive drugs, we are faced with an increasing burden of costs of care. Regarding palliative care in oncology it has been shown that (early) palliative care improves quality and possibly costs of care. 2
In order to determine whether these findings also apply in a general teaching hospital in the Netherlands, we first examined the needs for referral from general practitioners adherent to our hospital and medical specialists for ambulatory palliative care (APC) and IPC consultation (inpatient palliative care unit, PCU, within the medical oncology ward). The response rate for this inquiry was 108/242 (45%). Of them 66% required APC and 48% IPC. Based on this outcome, we initially instituted the IPC consultation project as a PCU within the medical oncology ward and later started an APC facility. We retrospectively evaluated whether specialized palliative inpatient care improves care of cancer patients in the nontumor-directed palliative phase and patient satisfaction as compared to standard care (SC) of these patients.
We found that the number of admissions was slightly higher in the PCU Group (n=55) as compared to the SC Group (n=45), whereas the number of admissions lasting more than eight days was significantly lower as was the number of additional medical examinations such as CT scans and the number of readmissions. Regarding patient satisfaction in the PCU Group, over 90% of the patients interviewed (n=36) considered the admission successful with respect to the items treatment goal, information given, speed of necessary actions, team cooperation, and fullfillment of desires.
We did not observe a lower admission rate as described by Tangeman et al. We believe, however, that this may be due to a possible lower threshold to incorporate dedicated inpatient palliative care into the oncology ward. IPC consultation appears to result in improved care for the patients and high rates of patient satisfaction, which is especially important in this phase of cancer. Having a PCU within the oncology ward brings palliative care-oncology ward partnership. In many hospitals these institutions are separated. However, decisions such as regarding stopping tumor-directed treatment or end-of-life issues can best be made multidiscplinary in close cooperation between dedicated palliative care workers and oncologists. Our focus was not on costs in this project. For further implications of this project this requires attention in addition to quality of care. IPC consultation teams as described by Tangeman provided that they act in close collaboration with the treating oncologist, constitute a valuable alternative, which was clearly shown to be cost-effective.