Specialty Palliative Care Consultation in Patients with Cervical Cancer: Who and Why?

Abstract

Background:

Palliative care (PC) is understudied in gynecological malignancies, particularly cervical cancer. We sought to investigate PC consultation, demographic, and clinical patterns in patients with cervical cancer at our institution.

Methods:

We performed a retrospective review of all cervical cancer diagnoses between January 1, 2018, and December 31, 2022. Patients were identified using Informatics for Integrating Biology and the Bedside. We abstracted demographic, treatment, and consult (inpatient and outpatient) information. We performed descriptive statistics, bivariate analysis, and multivariate regression analysis using SAS version 9.4.

Results:

We identified 821 patients; 144 (17.5%) had a PC consult, and 677 (82.5%) did not. Time from diagnosis to consult ranged from 0 to 325 months (median 16). Thirteen (9%) were referred within one month of diagnosis, and 31 (21.5%) between one and six months. Symptom management was the most common consult indication (77.8%), followed by goals of care (26.4%), end-of-life care (15.3%), and anxiety/depression (11.1%). PC consult was associated with more advanced stage (p < 0.0001), recurrence (p < 0.0001), increasing number of treatments (p < 0.0001), Medicaid insurance (p < 0.0001), single marital status (p = 0.0211), and younger age at diagnosis (p < 0.0001). Race was not associated with consultation (p = 0.4163).

Conclusions:

PC is underutilized in cervical cancer. Those who have a PC consult are younger, more likely to have higher-stage or recurrent disease, and to have received multiple treatments. Most consults are later in the disease, even those for pain/symptom management. Targeted efforts are necessary to develop sustainable methods for collaboration between gynecological oncology and PC providers.