Abstract Introduction
Patients with
head and neck cancer (HNC) experience unique physical and psychosocial challenges that impact their
health and
quality of life. Early implementation of
palliative care has been shown to improve various
health care outcomes. Objective The aim of the present study was to evaluate the patterns of
referral of
patients with HNC to
outpatient palliative care as they relate to utilization of
resources and
end-of-life discussions.
Methods We performed a retrospective
review of 245
patients with HNC referred to
outpatient palliative care services at two
Louisiana tertiary care centers from June 1, 2014, to October 1, 2019. The
control group consisted of those that were referred but did not follow-up. Reasons for
referral were obtained, and
outcome measures such as
emergency department (ED) visits,
hospital readmissions, and
advance care planning (ACP)
documentation were assessed according to predictive variables. Results There were 177
patients in the
treatment group and 68 in the
control group.
Patients were more likely to follow up to
outpatient palliative care services if referred for
pain management.
Hospital system, prior
inpatient palliative care, and number of
outpatient visits were associated with an increased likelihood for ED visits and
hospital readmissions. Those in the
palliative care treatment group were also more likely to have ACP discussions. Conclusion Early implementation of
outpatient palliative care among
patients with HNC can initiate ACP discussions. However, there are discrepancies in
referral reasons to
palliative care and continued existing barriers to its effective utilization.