• Posted December 28, 2023

Too Few Cancer Patients Get Palliative Care When Urinary Blockages Arise

The prognosis is poor for many cancer patients who develop serious urinary blockages, but researchers say less than half receive palliative care.

Palliative care aims to relieve pain and other symptoms of serious illness. Hospice care, one type of palliative care, is an option for patients who are expected to live no more than six months.

Hospice care can make patients comfortable and head off aggressive treatments for patients with malignant ureteral obstruction (MUO) who are nearing the end of life, said lead researcher Dr. Michael Felice, of Loyola University Medical Center in Maywood, Ill.

MUO is a serious blockage of the urinary tract caused by advanced cancer. It causes urine to accumulate in the kidneys, and while decompression treatments using stents or tubes can relieve the build-up, the prognosis is typically poor. The treatments are also invasive, complications are common and benefits are sometimes questionable, researchers report.

In the January issue of the journal Urology Practice, Felice's team looked at the use of palliative and hospice care among 115 MUO patients. They were diagnosed between 2014 and 2020.

Records showed that a minority of those patients -- 39% -- received palliative care. The average delay between MUO diagnosis and palliative care evaluation was two months. Researchers said just five of 45 patients were referred to palliative care before making decisions about decompression treatment.

"Earlier referral to palliative care might help to promote informed decisions about preferences for care among patients with MUO," Felice said in a journal news release.

In all, 54% of patients received hospice care. Median delay after MUO diagnosis was 144 days, meaning half entered hospice care sooner, half later. Once entering hospice, patients lived a median of 12 days.

Median time from MUO diagnosis to death was 141 days and survival was similar whether patients were in palliative care or not.

Of patients who died, the study found 43% had high use of health care, including repeated hospitalizations or emergency room visits. Of those who did not enter hospice, 86% had high end-of-life health care use.

"This highlights the impact of hospice in facilitating end-of-life discussion and enabling patients to decide how and where they spend their last days," the study said.

Hospice patients were 97% less likely to have high health care use at the end of their lives.

MUO patients "are ideal candidates for palliative care consultation, to help navigate the complexities of multidisciplinary care and guide decision-making," the authors wrote.

Because 8 in 10 study patients saw a urologist at some point during their MUO care, researchers said these specialists are well positioned to begin conversations about palliative care.

More information

The National Hospice and Palliative Care Organization outlines the similarities and differences between the two types of MUO care.

SOURCE: Wolters Kluwer Health, news release, Dec. 21, 2023