Timely introduction of palliative care needed to improve outcomes for people with metastatic prostate cancer

Prostate cancer is the second leading cause of cancer death in Australian males. While the high prevalence of metastatic prostate cancer is known, little attention has been given to the palliative care needs of these patients, who often experience significant symptom burden and deterioration in quality of life during the advanced stages of their illness.

In a paper published today in BJU International, researchers at the University of Melbourne have outlined current healthcare practices for people who die from metastatic prostate cancer. The research has enabled the identification of opportunities to improve the quality of care for patients.

Recognising times when a person with prostate cancer might be expected to have increased palliative care needs appears to be a critical step in providing timely and appropriate access to support.

Dr Anna Collins

Dr Anna Collins, of the VCCC Palliative Medicine Research Group and the University of Melbourne Centre for Cancer Research, said that considering appropriate benchmarks for palliative care engagement at standardised times in the illness course may help to facilitate quality end of life care for people with metastatic prostate cancer.

“To better support patients and their families, standardised timelines for palliative care engagement should be introduced to benchmark, map and improve the quality of end-of-life care.”

“We propose that, this standardisation should take place at the first multi-day admission with metastatic prostate cancer, as a minimum requirement. This provides a readily-identifiable point which is grounded in the illness course, and represents a time of high health service use and poor prognosis. It can serve as a prompt for clinicians to add that additional layer of support, if this is not already in place.”

The majority of patients with metastatic prostate cancer die in hospital, with most having at least one indicator of care that is considered less optimal by patients at the end of care. This presents vital opportunities for improvement in end-of-life care for these patients.

Despite evidence that the terminal trajectory can be recognised earlier than other cancers, the study showed that timely palliative care referrals were not always enacted.

The study found that 60% of patients access palliative care, typically within the final month of life. It revealed that access to palliative care is not universal, and for the majority of patients it occurs late.

The group have proposed future studies detailing access to and use of palliative care based on standardised times of engagement, adding to the growing body of evidence highlighting the benefit of early palliative care integration.