PALL-02. THE IMPACT AND VALUE OF INTEGRATING PALLIATIVE CARE INTO A NEURO-ONCOLOGY CLINIC

Abstract

BACKGROUND: Palliative care in oncology enhances symptom management and improves survival. As reimbursement shifts from fee for service to value based population health, this study measures the impact of adding a palliative care provider (PCP) in neuro-oncology. METHOD(S): Over six months, a palliative nurse practitioner was integrated into a weekly multidisciplinary brain and spine oncology clinic. The provider participated in the conference reviewing recent MRIs and discussing current disease status and treatment options. The PCP would consult on up to four of the clinic patients. Data were recorded regarding patient characteristics, goals of care, and changes in therapy. RESULT(S): Of the cases who met with the palliative provider for formal consultation, the most common diagnoses were 41.6% with metastatic lung cancer and 25% with glioblastoma. For goals of care, an Advanced Directive discussion was documented in 100%. Do Not Resuscitate (DNR) orders were activated in 37.5% and documented in 54%. Medical Orders for Scope of Treatment (MOST) forms were introduced in 87.5% and completed in 25%. For changes in therapy, enrollment in hospice occurred in 33.3%. Pain medication was changed in 33.3%. Other symptoms including fatigue, weakness, anorexia, constipation, anxiety, lymphedema, dysphagia, depression, insomnia, and alopecia were managed in 87.5%. Using accepted cost savings models, $72,000 was saved due to hospice enrollment and $110,400 was saved by consulting palliative care yielding an anticipated annual savings of $364,800 to the population by adding a 0.1 FTE to the clinic. CONCLUSION(S): This study suggests that a PCP in neuro-oncology can produce a high rate of establishing goals of care. A PCP can significantly reduce the cost of care in a value based model. Further study on the impact of palliative care in neuro-oncology seems warranted.