Availability and integration of palliative care at US cancer centers.
BACKGROUND
The current state of palliative care in cancer centers is not known.


OBJECTIVE
To determine the availability and degree of integration of palliative care services and to compare between National Cancer Institute (NCI) and non-NCI cancer centers in the United States.


METHODS
A survey of 71 NCI-designated cancer centers and a random sample of 71 non-NCI cancer centers of both executives and palliative care clinical program leaders, where applicable, regarding their palliative care services between June and October 2009. Survey questions were generated after a comprehensive literature search, review of guidelines from the National Quality Forum, and discussions among 7 physicians with research interest in palliative oncology. Executives were also asked about their attitudes toward palliative care.


METHODS
Availability of palliative care services in the cancer center, defined as the presence of at least 1 palliative care physician.


RESULTS
A total of 142 and 120 surveys were sent to executives and program leaders, with response rates of 71% and 82%, respectively. National Cancer Institute cancer centers were significantly more likely to have a palliative care program (50/51 [98%] vs 39/50 [78%]; P = .002), at least 1 palliative care physician (46/50 [92%] vs 28/38 [74%]; P = .04), an inpatient palliative care consultation team (47/51 [92%] vs 28/50 [56%]; P < .001), and an outpatient palliative care clinic (30/51 [59%] vs 11/50 [22%]; P < .001). Few centers had dedicated palliative care beds (23/101 [23%]) or an institution-operated hospice (37/101 [37%]). The median (interquartile range) reported durations from referral to death were 7 (4-16), 7 (5-10), and 90 (30-120) days for inpatient consultation teams, inpatient units, and outpatient clinics, respectively. Research programs, palliative care fellowships, and mandatory rotations for oncology fellows were uncommon. Executives were supportive of stronger integration and increasing palliative care resources.


CONCLUSIONS
Most cancer centers reported a palliative care program, although the scope of services and the degree of integration varied widely.
Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
David
D
Hui
Ahmed
A
Elsayem
Maxine
M
De la Cruz
Ann
A
Berger
Donna S
DS
Zhukovsky
Shana
S
Palla
Avery
A
Evans
Nada
N
Fadul
J Lynn
JL
Palmer
Eduardo
E
Bruera
D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D019033:Delivery of Health Care, Integrated; D019538:Health Care Surveys; D006738:Hospices / Q000706:statistics & numerical data; D006801:Humans; D054547:National Cancer Institute (U.S.); D009369:Neoplasms / Q000628:therapy; D010166:Palliative Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D014481:United States; D000078329:Workforce