Effects of integrating palliative care on the uptake of advance care planning among elderly patients with advanced genitourinary cancers.

49 Background: Integrating palliative care (PC) into oncology has been demonstrated to significantly enhance the quality of life for these patients and facilitating patient decision-making, particularly concerning advance care planning (ACP). ACP is a structured process that ensures patients' values and preferences regarding the end-of-life care are respected, and frequently results in the completion of advance directives (AD). This study aims to evaluate the impact of PC on the uptake of ACP among patients with advanced GU cancers. Methods: A retrospective analysis was conducted using a claims database from Ramathibodi Hospital, encompassing elderly cancer patients who had a medical claim for death between Jan1, 2016, and Dec31, 2021 included 1,013 patients, with 532 males, and a mean age of 72.37 years (60.5-99). Among these, 215 patients (21.2%) received integrated palliative care (PC). 102 patients with GU malignancies, including 44 with TCC, 36 with prostate cancer, 22 with RCC. Of these, 22 patients (21.6%) were treated with PC. The primary outcomes measured were the completion rates of ACP and AD. Secondary outcomes included the utilization of treatments in the 6 months preceding death. Comparative analyzes were performed between the PC and UC groups to assess the impact of PC on these outcomes. Results: Regarding ACP, 78.9% of patients in the UC group engaged in ACP, with a median time of 4.5 days (range: 0-324 days) before death. In contrast, 100% of patients in the PC group engaged in ACP, with a median time of 259.7 days (range: 0-2,077 days) before death. 46.5% of patients in the PC group completed AD, whereas no patients in the UC group completed AD. Patients receiving palliative chemotherapy within 30 days before death were significantly lower in the PC group, with an odds ratio of 3.30 (P < 0.001). In the 6 months preceding death, the PC group exhibited significantly lower ER visits (P = 0.011), inpatient admissions (P < 0.001), and total hospital visits (P = 0.002) compared to the UC group. Conclusions: Integrating palliative care into the oncology treatment framework significantly improves the uptake of ACP among patients with advanced GU cancers. This comprehensive approach not only reduces the utilization of aggressive treatments near the end of life, but also enhances the alignment of medical care with patients' values and preferences. Clinical trial information: COA. MURA2023/258 .