A total of 83 BC patients were seen. Of these, 76 (91.6%) suffered from inoperable metastases while the others (8.4%) suffered from inoperable locally advanced disease. The number of male patients was 2 (2.4%), the median age of the entire group was 61 years (range 33–84 years). Of all patients, most (n = 68; 82%) were seen in the department of senology, while the other consultations were requested by the radiotherapy, general surgery or internal medicine departments.
The number of new consultations increased from 29 (34.9%) during the first to 54 (65.1%) new BC patients in the second half of the observation period (CI 53.8–75.2%; p = 0.008).
PC Integration: Early or Late in the Disease Trajectory?
As indicators for the timing of PC integration, we analyzed (i) performance status and (ii) symptoms as markers for advanced disease (e.g. dyspnea) [3
]. About every second patient was already in a considerably decreased physical state (ECOG 3 and 4) (table ). When comparing the 1st to the 2nd year, this did not change significantly, although a tendency towards fewer patients with ECOG 4 was seen.
Performance status (ECOG), n = 83
The prevalence of pain, dyspnea and other burdening symptoms did not decrease significantly after a 1-year period (table ). Likewise, the overall prevalence of symptoms per patient decreased non-significantly from 5.0 to 3.0 (p = 0.3037).
Symptom burden at initial consultation (n = 83)
Other PC Issues
Patients received counselling by the PCST for a median of 7 days (range 1–239 days). 28 patients (34%) were seen for a period of less than 3 days, 57 patients (69%) were seen for less than 1 month (31 days) and 8 (10%) for more than 3 months.
Most PC consultations were specifically requested for symptom control (n = 80; 96%). Of these, 53 (64%) concerned pain management.
The number of cancer pain patients receiving opioid rescue medication increased significantly from 10 (12.0%) to 45 (54.2%) after PC consultation (difference 42.2%; CI 28.9–53.4%; p < 0.0001). Such a significant increase could also be demonstrated for cancer pain patients who were receiving strong opioids (WHO III). This number increased from 25 (30.1%) to 47 (56.6%) (difference 26.5%; CI 16.4–35.6%; p < 0.0001).
Of all patients, 19 patients (22.9%) suffered from dyspnea. 4 of these patients (21.1%) received WHO III opioid medication prior to consultation. This number rose significantly to 12 of the 19 patients (63.2%) (difference 42.1%; CI 15.1–60.9%; p = 0.013) after consultation. Only 1 (5.3%) of the dyspnea patients received a WHO III rescue medication before consultation, increasing 9-fold to 9 (47.4%) afterwards (difference 42.1%; CI 14.4–63.4%; p = 0.013).
In the second half of the observation period, non-PC physicians increasingly requested PC support for social or communicative interventions (from 13.8% (n = 4) to 20.4% (n = 11); difference 6.6%; CI −12.3–21.6%; p = 0.559) (table ).
Development of requests and interventions not regarding symptom control (n = 83)
Apart from measures concerning symptom control, PC interventions resulted in clarification of social or communicative issues (n = 51; 62%) and assessment of the indication for admittance to the PC ward (n = 16; 19%). Psychosocial interventions that had to be conducted by the support team were thorough and detailed explanations of the different aspects and options of PC (n = 40; 48%), structured conversations with relatives (‘physician-family rounds’) (n = 13; 15.7%), and coordination of social work (n = 9; 10.9%).