Early specialised palliative care for unresectable pancreatic cancer - a quasi-experimental study

CONTEXT: Patients with unresectable pancreatic cancer have a poor prognosis and often high health care requirements.

OBJECTIVES: To evaluate the impact of early specialised palliative care for patients with unresectable pancreatic cancer on hospital use.

METHODS: Using a quasi-experimental design, newly diagnosed patients with unresectable pancreatic cancer diagnosed from October 2019 to February 2021 were offered specialised palliative care delivered as home-visits (n=65). The retrospective control cohort were similar patients diagnosed between December 2017 and April 2019 (n=60). The primary endpoint was use of hospital care. Secondary outcomes included survival, quality of life and place of death.

RESULTS: Median overall survival was significantly longer in the intervention cohort compared with the control cohort, 8.0 months (95% CI, 5.9-10.0) vs 4.9 months (95% CI, 3.5-6.3) (P = 0.029). There was no difference in use of hospital care between the cohorts, but given the longer survival in the intervention cohort there were significant reductions in monthly hospital admissions, 0.8 vs 1.2 (P = 0.002), emergency department admissions, 0.4 vs 0.6 (P = 0.009) and days in hospital, 4.2 vs 7.2 (P = 0.001) in the intervention cohort compared with the control cohort. The proportion of patients who died in hospital outside the palliative care unit was significantly lower in the intervention cohort compared with the control cohort, 14.5% vs 30.5% (P = 0.035).

CONCLUSION: Early specialised palliative care for patients with unresectable pancreatic cancer resulted in an increase in survival without an increase in use of hospital care.