The inclusion of palliative care in initial treatment planning for women with gynecologic cancer and the use of advanced directives.

23 Background: To determine differences in Advanced Directive (AD) utilization among women with gynecologic cancer at a facility with a functioning Palliative Care (PC) program, vs those in a facility without access to a PC program. Also, to identify possible ethnic differences or relationships to other PC needs to AD utilization.

METHODS: 95 subjects with gynecologic cancer were prospectively identified, 30 from an inner-city academic facility (Site A), and 65 from a suburban community facility in the same metropolitan area. (Site B) All patients received treatment from board-certified oncologists. All subjects were approached by Master's trained Social Workers at presentation with a diagnosis of cancer and asked to complete a standardized, validated questionnaire (modified Distress Thermometer (DT)) to determine their palliative care needs and whether they had an AD prior to treatment (baseline), and 6 months later. Completed questionnaires were collected and data was depersonalized and analyzed by the authors. Statistical differences were assessed using standard methods.

RESULTS: Site A patients were younger (56.3 vs 61.5 years) less likely to be Caucasian (12/30, 40% vs 40/65, 61.5%) and less likely to have private insurance (10/30, 33.3% vs 41/65, 63%). The presence of AD was similar in both sites at baseline. (8/65, 12.3% vs. 4/30, 13.3%) At 6 months, Site B patients were more likely to have an active AD. (50/65, 77.0% vs 5/30, 16.7%) No differences were seen based on ethnicity (Caucasian vs. Black) at either baseline or 6 months. No differences were seen based on the stage or type of gynecologic cancer. No relationship between AD utilization and any other PC needs (as recorded by DT) were identified. All differences were significant at a p < 0.05.

CONCLUSIONS: Advanced Directive utilization is uncommon in women diagnosed with gynecologic cancer in the facilities analyzed. Subsequent creation of an AD is strongly associated with the presence of a PC program. PC programs have multiple benefits for gynecologic cancer patients, and should be offered routinely as part of the initial treatment plan.