(UroToday.com) The 2025 American Society of Clinical Oncology (ASCO) Genitourinary (GU) Annual Symposium held in San Francisco, CA was host to a prostate cancer prostate session. Dr. Phichai Chansriwong presented the results of a study evaluating the effects of integrating palliative care on the uptake of advanced care planning among elderly patients with advanced genitourinary cancers.
Integrating palliative care into oncology has been shown to significantly enhance patients’ quality of life and facilitate patient decision-making, particularly with regard to advanced care planning.1,2Advanced care planning is a structured process that ensures patients' values and preferences regarding end-of-life care are respected and frequently results in the completion of advanced directives. This study aims to evaluate the impact of palliative care on the uptake of advanced care planning among patients with advanced genitourinary cancers.
This was a retrospective analysis that was conducted using a claims database from Ramathibodi Hospital, which included elderly cancer patients who had a medical claim for death between January 1st, 2016, and December 31st, 2021. The primary outcomes were the completion rates of advanced care planning and advanced directives. Secondary outcomes included the utilization of treatments in the 6 months preceding death, including emergency room visits, inpatient admissions, and total hospital visits. Information regarding systemic anticancer treatments administered at 2 weeks, 1 month, 3 months, and 6 months preceding death were abstracted. Comparative analyses were performed between the palliative and ‘usual care’ groups to assess the potential impact of palliative care on these outcomes.
The study cohort included 1,013 patients. The mean patient age was 72 years. Overall, 215 patients (21%) received integrated palliative care, and 79% were treated with ‘usual care’. One hundred and two patients with genitourinary malignancies were included
- Urothelial carcinoma: 44
- Prostate cancer: 36
- Renal cell carcinoma: 22
Of these 102 patients, 22 (21.6%) received palliative care.
79% of patients in the ‘usual care’ group engaged in advanced care planning, at a median time of 4.5 days (range: 0–324 days) prior to death. In contrast, 100% of patients in the palliative care group engaged in advanced care planning, at a median time of 259.7 days (range: 0–2,077 days) prior to death. 46.5% of patients in the palliative care group completed advanced directives, whereas no patients in the ‘usual care’ group completed advanced directives.
In the 6 months preceding death, the palliative care group was significantly less likely to require emergency room visits (p=0.011), inpatient admissions (p<0.001), and total hospital visits (p=0.002), compared to the ‘usual care’ group.
The proportion of patients receiving palliative chemotherapy within 30 days prior to death was significantly lower in the palliative care group (OR: 0.30; p< 0.001). However, no significant differences were observed in the utilization of targeted therapy and immunotherapy.
The study investigators concluded that:
- Integrating palliative care into the oncology treatment framework significantly improves the uptake of advanced care planning among patients with advanced genitourinary cancers.
- This comprehensive approach not only reduces the utilization of aggressive treatments near the end-of-life, but also enhances the alignment of medical care with patients' values and preferences.
Presented by: Phichai Chansriwong, MD, MSc, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Written by: Rashid K. Sayyid, MD, MSc – Robotic Urologic Oncology Fellow at The University of Southern California, @rksayyid on Twitter during the 2025 Genitourinary (GU) American Society of Clinical Oncology (ASCO) Annual Meeting, San Francisco, CA, Thurs, Feb 13 – Sat, Feb 15, 2025.
References:
- Castro JA, Hannon B, Zimmermann C. Integrating Palliative Care into Oncology Care Worldwide: The Right Care in the Right Place at the Right Time. Curr Treat Options Oncol. 2023; 24(4):353-372.
- Ferrell BR, Temel JS, Temin S, et al. Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2017; 35(1):96-112.