A recent study has found that less than half of patients with malignant ureteral obstruction (MUO) – a serious complication of advanced cancer with a poor prognosis – receive palliative care (PC) for their condition. The study was conducted by Michael D. Felice, MD, from the Loyola University Medical Center, and was published in the January issue of Urological Practice®, an official journal of the American Urological Association (AUA) published in the Wolters Kluwer’s Lippincott portfolio.
The study suggests that hospice care could promote patients‘ well-being and avoid aggressive and invasive treatments for MUO patients approaching the end of life. „Earlier referral to palliative care could help promote informed decision-making about care preferences in MUO patients,“ commented Dr. Felice.
New Insights On Palliative Care Use in MUO
Malignant ureteral obstruction is a condition in which the urinary tract is blocked due to advanced cancer. Patients with MUO have a limited life expectancy, with many spending a significant portion of their remaining life in the hospital. Over time, MUO leads to the accumulation of urine in the kidneys, a condition known as hydronephrosis. Decompression treatments can alleviate the buildup, but they are invasive procedures with high complication rates and sometimes questionable benefits.
For patients with advanced cancer, palliative care aims to improve symptoms, mental and emotional health, while ensuring that all further cancer treatments reflect the patient’s care goals. Hospice care, a subset of palliative care, is an option for patients with an estimated survival of less than six months.
According to Dr. Felice and colleagues, „Simultaneous dedicated palliative care and oncology treatment are recommended for patients with advanced cancer.“ However, the utilization of palliative care by patients with MUO remains unclear. The researchers examined the utilization of palliative care and hospice care in 115 patients diagnosed with MUO between 2014 and 2020.
Only 39% of patients with MUO received palliative care upon reviewing medical records. On average, there was a two-month delay between the MUO diagnosis and the assessment for palliative care. Only five out of 45 patients were referred to palliative care before the decision about decompression treatment.
Role of Urologists in Early Referral to Palliative Care
54% of patients received hospice care, on average 144 days after the MUO diagnosis. The average time from admission to hospice until death was 12 days.
85% of patients died or were presumed to have died at the time of the study. The median time from MUO diagnosis to death was 141 days, with the survival rate in patients who received palliative care and those who did not receiving similar care.
Of the deceased patients, 43% had a high healthcare utilization, based on factors such as repeated visits to the emergency room or hospital stays in the last month of life or deaths in the hospital. Of the patients who did not receive hospice care, 86% had high healthcare utilization at the end of life. „This emphasizes the impact of hospice care in facilitating end-of-life discussions and the opportunity for patients to decide for themselves how and where they spend their final days,“ the researchers write. An adjusted analysis showed that the likelihood of patients receiving intensive medical care at the end of their lives was 97% lower if they received hospice care.
Patients with MUO „are ideal candidates for palliative care consultation to navigate the complexity of multidisciplinary care and make decisions,“ write Dr. Felice and co-authors. „Ideally, patients would be referred to PC after the MUO diagnosis and before the decision about urine decompression.“
The researchers note that 80% of the study patients with MUO consulted a urologist at some point during their treatment. They conclude, „Urologists may be particularly well positioned to promote interdisciplinary collaboration and initiate conversations about the inclusion of palliative care due to our varied engagement in the care of patients with MUO.“
Felice, MD, et al. (2024). The current status of palliative care, hospice, and end-of-life healthcare utilization in patients with malignant ureteral obstruction. Urology Practice. doi.org/10.1097/upj.0000000000000472.