A pre-post intervention study on the effects of implementation of a Palliative Care Pathway for patients with advanced cancer: less medical interventions during the last three months of life

Abstract Purpose: Adequate integration of palliative care in oncological care can improve the quality of life of patients with advanced cancer. Whether such integration affects the use of diagnostic procedures and medical interventions has barely been studied. We studied the effect of implementation of a standardized Palliative Care Pathway in a hospital on the use of diagnostic procedures, anticancer treatment, and other medical interventions for patients with incurable cancer in the last three months of life.Methods: In a pre- and post-intervention study, data were collected concerning adult patients with cancer who died between February 2014 and February 2015 (pre-PCP period) or between November 2015 and November 2016 (post-PCP period). We collected information on diagnostic procedures, anticancer treatments and other medical interventions during the last three months of life.Results: We included 424 patients in the pre-PCP period and 426 in the post-PCP period. No differences were found for the percentage of patients for whom laboratory tests (85% vs 85%, p=0.795) or radiological procedures (85% vs 82%, p=0.246) were performed. The percentage of patients who received anticancer treatment or other medical interventions was lower in the post-PCP period (40% vs 22%, p<0.001; and 42% vs 29%, p<0.001, respectively). Conclusions: Implementation of a PCP resulted in fewer medical interventions, including anticancer treatments, in the last three months of life. Implementation of the PCP may have created awareness among physicians of patients’ impending death, thereby supporting caregivers and patients to make appropriate decisions about medical treatment at the end of life.Trial registration number: Netherlands Trial Register; clinical trial number: NL 4400 (NTR4597); date registrated: 2014-04-27