Dr Prunella Blinman: is the time burden of palliative chemo too much?

End-of-life care

By Mardi Chapman

29 Apr 2020

Dr Prunella Blinman

Time spent commuting to and waiting for health care appointments is a significant contributor to the treatment burden in cancer patients with a shortened life expectancy.

A US study assessing the opportunity costs of palliative chemotherapy in 362 patients with metastatic pancreatic ductal adenocarcinoma found just over 50% of total hours devoted to healthcare was spent travelling or waiting to receive care.

Patients in the study had an overall survival of 230 days of which 22 days (10%) included healthcare encounters such as doctor visits, laboratory tests, infusions and radiology visits.

Overall, patients spent 92.3 hours engaging in outpatient health care – 43.6 hours of care time with a healthcare provider and 53.2 hours in non-care time such as travelling and waiting.

The retrospective study, published in JCO Oncology Practice, aimed to capture real-world experience by using real-time metrics such as patient-specific clinic check-in times and chemotherapy infusion and radiation therapy start times.

The authors said understanding the patient experience was important to guide informed consent and identify inefficiencies in the delivery of cancer care.

“This knowledge is particularly important for patients with metastatic pancreatic cancer receiving palliative chemotherapy, as the expected overall survival is a mere 6-11 months.”

“Our results demonstrate that the total time patients spend interacting with the healthcare system is substantial and signals the need to create innovative care models to reduce treatment burden and streamline care delivery,” they concluded.

Commenting on the study, Dr Prunella Blinman told the limbic the study was not perfect but important and had made a decent attempt to try and quantify the time spent accessing care.

“It’s a patient-centred study trying to define the burden of chemotherapy in patients with advanced pancreatic cancer who on the whole have a shorter survival than many other advanced cancers.”

“Fundamentally it’s about providing patients with the information they need to make an informed decision about whether to have chemotherapy or not.”

Dr Blinman, from the University of Sydney and Concord Cancer Centre, said the time burden of chemotherapy should be carefully explained for patients in the discussion surrounding benefits and harms of care.

“In metastatic pancreatic cancer, like in any other metastatic cancer where the aim is not cure, chemotherapy aims to either help people live longer or live better and ideally should be achieving both of those.”

She said patients who spent less time at hospital might be able to spend more time doing the things they enjoy.

“And so patients do need to factor that in as to whether or not they think the trade-off of chemotherapy is going to be worthwhile for them. It’s an individual judgement and not a judgment that clinicians can make on behalf of patients.”

Dr Blinman said the study also highlighted that there was room to improve processes like treatment or appointment scheduling in order to minimise the time patients spent in non-care.

“Everyone would agree that health systems could work more efficiently and better, faster, smoother.”

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