Learning Objective #1: Recognize the value of collecting sequential, specific outcome data on a population of interest in order to improve care

Learning Objective #2: State why the infusion room in a cancer center is a critically important palliative care delivery arena

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Introduction During palliative chemotherapy there is ambiguity regarding the timing of, and provider responsible for, the provision of palliative care. Chemotherapy infusion room nurses administer 80% of the nation's chemotherapy but are largely ignored as potential palliative-care providers.

Purpose: Analysis of current infusion room practice in a breast cancer clinic of a large urban cancer center in order to 1) determine patient care needs through infusion room practice analysis and to 2) justify adding palliative care content to the standard education of infusion room nurses for optimal delivery of palliative care.

Methods Retrospective, repeated measures chart review (Jan, 1999 through October, 2004) of 409 women from the University of Pittsburgh Cancer Institute (UPCI/BCP) Breast Cancer Program. There were 24 baseline and 20 monthly measurements according to a chart abstraction protocol.

Sample: N = 380 (n=186 deceased, 194 alive). Women from 1/99 through 10/04 with metastatic breast cancer seen at the UPCI /BCP.

Results: Analyzed for deceased patients (n=186). Total months of survival were 24.9 (range 1 – 103) months, SD18.5. 156/186 (84.7%) received chemotherapy and 132/186 (71.7%) received some type of parenteral supportive therapies (biphosphonate, transfusion, growth factor) over the course of illness.

End of life infusion care: In the last month of life, 46.2% of all patients (n=86) received care in the infusion room, (chemotherapy 28.3% (n=53) and/or parenteral supportive therapies, 31.6% (n=59). Within the last 3 months of life, 81.7% (152/186) of all deceased patients had received chemotherapy 55.8% (n=120) and /or parenteral supportive therapies, 50.2% (n=108) in the infusion rooms.

Discussion: Implications for this application: This extensive cohort database defines MBC patient treatment patterns. These data support the need to 1) better address patient needs through attention to palliative care issues in the chemotherapy infusion rooms 2) train nurses to integrate palliative care into infusion room practice.