1451P An onco-palliative expertise unit in a French comprehensive cancer center: Experience at 2 years

Abstract

Background: The implementing of an Onco-Palliative Expertise Unit (OPEU) in a large Comprehensive Cancer Center (CCC), responds to a need to develop advanced care planning and to integrate palliative care into a shared care project. Methods: Our 10-bed unit opened on March 1, 2019. Its aim is to provide enhanced care for complex patients and to facilitate decision-making in advanced palliative care. The main goal of hospitalizations in this OPEU is to rethink the therapeutic project with oncologists, patients and their families and take care of refractory symptoms. Results: Two years after opening, our unit has received 522 pts, mean age 58 years (24-94), in 666 stays. 50% came from the home. 81,5% of patients were PS ≥3 and 89% in metastatic stage. Almost half of them were already followed by the palliative care team. After an average length of stay of 10.7 days (median 9 days), discharge was distributed between return home (38%), a palliative care unit (22%), death (26%) and other oncology units, or hospitals (14%). At the opening, refractory symptoms were the most frequent reason for hospitalization (67% of stays). For the first 6 months period to the second one, discussing the therapeutic project increased from 23% to 34% of the hospitalization causes, showing the appropriation of this unit by the oncologists. On admission, specific cancer treatment was ongoing for 54% of stays. After assessment and multidisciplinary discussion, 49,6% of them decided to stop chemotherapy. Conversely, the start or resumption of treatment was recommended for 12,8% of stays without specific treatment on admission. Comparing the first and second year of opening, the objectives stays and characteristics of the patients remain stable, apart from the deaths in the unit which have increased, probably partly explained by the COVID-19 pandemic. Conclusions: The creation of an OPEU in a CCC allows getting around the taboo of palliative care. It supports the dialogue between the oncologist and the pt, allows the pt to make the therapeutic project evolve toward a life project, avoiding costly unreasonable obstinacy. After 2 years, our unit has proved its usefulness but it would be interesting to evaluate the satisfaction and opinion of oncologists. We also have plans now to develop clinical research in the unit. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.