1. MASCC Survey for Palliative Care Mellar P Davis MD FCCP FAAHPM

2. MASCC Survey for Palliative Care 183 respondents completed at least part of the survey. 19 (10%) were from NCI designated cancer centers (15 of which were comprehensive cancer centers). 34 (19%) were from ESMO designated centers. 65 (36%) were from other cancer centers. 45 (25%) were from urban hospitals/clinics. 7 (4%) were from rural hospitals/clinics. 11 (6%) were from hospice centers.

3. MASCC Survey for Palliative Care The questions scored on a 0-10 scale are reported both uncoded and arbitrarily coded with scores of 0-3 indicating a negative response, 4-7 a neutral response, and 8-10 a positive response

4. Availability Overall most institutions (83%) had PC available sometime during the past 10 years, most (93%) are under the leadership of an M.D., most (91%) have at least one PC physician on staff, and most (84%) have dedicated inpatient beds for cancer care

5. Service Structure The most commonly offered PC services are consultation/mobile team service (72%) and PC/supportive care clinics (64%), with 52% of respondents indicating that both services are available at their institutions Only 39% of respondents indicated that dedicated PC acute care beds were available, and 21% indicated that there was institution-operated hospice.

6. Barriers The barriers to PC access most commonly noted were: Limited budget (55%) Lack of adequately trained PC physicians and nurses (40%) Poor reimbursement (32%) 5% of respondents identified lack of evidence that PC improves patient outcome as a barrier 4% indicated that a potentially negative impact on the hospital’s national ranking was a barrier

7. Effectiveness In general respondents indicated that the effectiveness and quality of their PC program has improved a bit over the past 5 years (median 1 level change in effectiveness and median 2 level change in quality, p<.0001 in both cases; Wilcoxon signed rank test) 2% of centers indicating effectiveness has decreased 63% effectiveness has increased 3% indicating the quality has decreased 69% quality increased

8. Research Respondents were in general agreement that stronger integration of PC into oncology practice would benefit patients, and that more research funding should go to PC (median score of 10 for both questions). However only 17% indicated that their institution was likely (scores 8-10) to increase PC funding.

9. Increasing Staff Respondents were generally neutral regarding future hiring plans – the median scores for increasing staffing of PC M.D.s, mid-level providers, and PC nurses were all 5; with roughly equal numbers of respondents indicating they are likely (scores 8-10) and unlikely (scores 0-3) to hire each type of provider.

10. Palliative Beds Respondents tended to have a slight negative bias in terms of plans to increase the number of PC acute beds at their institutions – median score was 4 49% of respondents indicating they are unlikely (scores 0-3) to increase the number 18% indicating the number is likely (scores 8-10) to be increased.

11. Comparisons The respondents from the different institution types answered a number of questions similarly (e.g. program leadership, several barriers to PC access, effectiveness of pain management services, need for stronger integration of PC into oncology practice, the likelihood of increasing PC nursing staff, and the likelihood of increasing the number of PC acute beds), however they also differed in a number of ways

12. Comparisons Cancer centers (NCI, ESMO, other) tended to have had PC services available sometime during the past 10 years more frequently than urban hospitals/clinics (85-100% vs 64%, p=.0002). Cancer centers (NCI, ESMO, other) tended to have PC physicians on staff more frequently than urban hospitals/clinics (95-100% vs 72%), p=.0004.

13. Comparisons NCI and ESMO designated centers tended to offer PC services more frequently than urban hospitals/clinics, with other cancer centers varying between the two (p<.005 for all services except dedicated PC acute care beds and institutional-based hospice). ESMO designated centers had dedicated PC acute care beds more frequently than other institutions (76% vs 24- 32%), p<.0001.

14. Comparisons ESMO designated centers considered poor reimbursement a barrier to PC access more frequently than other types of institutions (53% vs 23-32%), p=.02. NCI and ESMO designated centers tended to score the quality of their PC services higher than urban hospitals/clinics, with other cancer centers between the two (63-71% of NCI and ESMO designated centers gave scores of 8-10 versus 53% of other cancer centers, and 33% of urban hospitals/clinics), p=.001

15. Comparisons Cancer centers (NCI, ESMO, other) tended to score the likelihood of increasing PC physicians higher than urban hospitals/clinics (12-25% of cancer centers gave scores of 0-3 and 35-39% gave scores of 8-10, compared to 37% and 12%, respectively, for urban hospitals/clinics), p=.007

16. Comparisons Cancer centers (NCI, ESMO, other) had dedicated beds for cancer patients more frequently than urban hospitals/clinics (84-91% vs 69%), p=.01

17. Comparisons Respondents from NCI and ESMO designated centers tended to answer the survey similarly, however there were some differences: Dedicated PC acute care beds greater with ESMO ESMO designated centers scored the current effectiveness of their pain management programs higher than respondents from NCI designated centers (79% of ESMO designated centers scored 8-10 while none gave a score <4, compared to 56% and 6%, respectively for NCI designated centers), p=.05

18. Summary Most institutions had PC available sometime during the past 10 years Most commonly offered PC services are consultation/mobile team service and PC/supportive care clinics Barriers to PC access were limited budget, lack of adequately trained PC physicians and nurses and poor reimbursement

19. Summary In general respondents indicated that effectiveness and quality of their PC program has improved Respondents were in general agreement that stronger integration of PC into oncology practice would benefit patients, and that more research funding should go to PC

20. Summary Respondents were generally neutral regarding future hiring plans Only 17% indicated that their institution was likely (scores 8- 10) to increase PC funding Respondents tended to have a negative bias in terms of plans to increase the number of PC acute beds