Palliative care is underused for patients with malignant urinary obstruction

Less than half of patients with malignant ureteral obstruction (MUO)-a serious complication of advanced cancer, with a poor prognosis-receive palliative care (PC) for their condition, reports a paper in the January issue of Urology Practice, an Official Journal of the American Urological Association (AUA). The journal is published in the Lippincott portfolio by Wolters Kluwer.

Malignant ureteral obstruction is a condition in which the urinary tract is blocked due to advanced cancer. Patients with MUO have limited life expectancy, and some spend much of their remaining life in the hospital. Over time, MUO leads to buildup of urine within the kidneys, a condition called hydronephrosis. Decompression treatments can relieve the buildup, but these are invasive procedures with high complication rates and sometimes questionable benefits.

For patients with advanced cancer, palliative care aims to improve symptoms and mental and spiritual health while ensuring that any further cancer treatments reflect the patients' goals of care. Hospice care, a subset of palliative care, is an option for patients with expected survival of less than six months.

"Concurrent dedicated palliative care services and oncologic treatment is recommended for patients with advanced cancer," Dr. Felice and colleagues write. However, the use of palliative care by patients with MUO remains unclear. The researchers evaluated the use of palliative care and hospice care among 115 patients diagnosed with MUO between 2014 and 2020.

On review of medical records, only 39% of patients with MUO received palliative care. On average, there was a two-month delay between MUO diagnosis and palliative care evaluation. Just five of 45 patients were referred to palliative care before decisions regarding decompression treatment.

Reference: Palliative care is underused for patients with malignant urinary obstruction; Urology Practice