Abstract 5026: Utilization of palliative medicine in a racially and ethnically diverse population of women with gynecologic malignancies
Authors: Nevadunsky Nicole S. , Brodt Zahava , Eti Serife , Selwyn Peter , Rapkin Bruce , Einstein Mark , Goldberg Gary 
Published: June 2012

Objective: There is limited information regarding the role of a palliative care consultation for ethnically and racially diverse women with gynecologic malignancies. The purpose of this study was to determine the characteristics, clinical findings and outcomes of patients with gynecologic malignancies who were referred for hospital inpatient palliative medicine consultation.

Methods: Patients with gynecologic malignancies were identified who requested a Palliative Medicine consultation from January 1, 2007 to June 1, 2010. Their medical records were reviewed for information including demographics, disease status, reasons for the consultation, clinical findings, interventions, and outcomes.

Results: 84 evaluable patients were identified. Forty-five percent (n=38) of patients were referred by their primary Gynecologic Oncologist. The average age was 63 years (range 22-96). The disease site was: uterus/endometrium (n=37, 44%), ovary (n=24, 29%), cervix (n=15, 18%), and vulva (n=5, 6%). Racial distribution included, African American (n=3, 39%), Caucasian (n=33, 28%), and Hispanic (n=13, 16%). Reasons for consultation were pain (n = 41; 45%), future goals of care (n=42; 46%) nausea/vomiting (n = 1; 1%), bowel obstruction (n=3, 3.3%) and dyspnea (n=4, 4%). Seventy-five percent of patients had medical co-morbidities, 27% had psychiatric co-morbidities and six patients were identified to have altered mental status at the time of interview. Eighty percent of patients were on narcotic medications at the time of consultation; however pain was adequately controlled in only 45% of patients. In 81% of the consultations, pharmacologic interventions were advised. The median number of days from consultation to death was 31. Hospice referral was recommended for 19 patients and thirty-eight patients were transitioned to “do not resuscitate” (DNR) status after consultation. The median number of days from DNR status to death was 19, and the median number of days from consult to DNR was 8. Sixteen patients (19%) died in the hospital setting.

Conclusion: This patient population represents a unique perspective of racial diversity and predominantly advanced or recurrent gynecologic cancers. Pharmacologic interventions were advised in the majority of consults, however end-of-life decision making was a common reason for consultation. The consultation team proved effective in transitioning patients to DNR status, however there may be barriers to early palliative intervention and symptom control as the median time of intervention to death was only one month. Pain and symptom control remain a significant challenge that earlier intervention may alleviate. This diverse, minority and low socio-economic status population may be resistant and/or unable to seek palliative care outside the hospital or their home.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 5026. doi:10.1158/1538-7445.AM2011-5026