Impact of the implementation of an embedded palliative care model in the continuum of care for patients with metastatic breast cancer

TL;DR

This study shows that integrating palliative care into the treatment of metastatic breast cancer leads to earlier referrals and better patient outcomes.

Contribution

The study evaluates a novel embedded palliative care model and its impact on care patterns and survival in metastatic breast cancer patients.

Findings

Early referrals to palliative care increased significantly after implementation.

A concurrent integrated care pattern was associated with a 4-month longer survival.

The embedded model did not affect 1-year survival rates but improved care coordination.

Abstract

Timely and integrated palliative care is crucial for patients with metastatic breast cancer. However, data on models of integration are scarce. We aimed to evaluate the impact of the integration of an embedded model of palliative care in a multidisciplinary breast unit on important goals of care and to characterize different patterns of integration (palliative predominant, oncology predominant or concurrent).

Single-center, retrospective, observational cohort study including all patients with metastatic breast cancer followed by the palliative and oncology teams from a 12-month period before (pre-implementation) and after (post-implementation) of an embedded model of integration of palliative care. We analyzed early integration, 1-year survival rate, survival and different patterns of coordination of palliative care and oncology (the oncology-predominant pattern, the palliative care-predominant pattern and the concurrent integrated care pattern).

From April 2020 to April 2022, a total of 145 patients were included in the analysis: all female, median age of 63.5 years, 20.7% with triple negative disease. Post-implementation, early referrals significantly increased (35.3 to 61.3%, p < 0.01), 1-year survival rate (40.1% vs 40.7%) and survival time were similar (9.2 months vs 9.9 months). An integrated pattern of care with concurrent palliative and oncology appointments was significantly more frequent (30% vs 61%, p < 0.01). When compared to the other patterns, the concurrent pattern was associated to a median of 4 months longer survival (p < 0.01).

The incorporation of an embedded model of palliative care was associated with earlier referrals and translated into better outcomes for patients with metastatic breast cancer.

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