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Poster Abstract submitted to the inaugural UKAOS conference 2024
Abstract title: Implementation of an Oncology Liaison Service in Malta: a three-month analysis
Authors: Mohamed Jomha (Mater Dei Hospital), Maria Masini (Mater Dei Hospital), Darlene Mercieca (Mater Dei Hospital), Claire Vella (Mater Dei Hospital)
Introduction
Malta is a Mediterranean country with a population of 530,000, covered by two acute general hospitals and one oncology centre, Sir Anthony Mamo Oncology Centre (SAMOC). Due to finite staffing and beds, outreach services provided by oncologists and palliative care specialists is limited. Cancer patients admitted with an acute medical issue are largely cared for by Internal Medicine physicians in an acute hospital setting.
The Oncology Liaison Service (OLS), which is manned by three Internal Medicine consultants with a special interest in palliative and cancer care, was established in March 2024 in Mater Dei Hospital, Malta’s largest acute hospital. The aims to provide continuity of care to all patients admitted within 6 weeks of oncological treatment or undergoing palliation.
Method
This retrospective cross-sectional analysis included all patients admitted under the OLS over 9 weeks from the 18th March – 9th June 2024. Admission notes were analysed for demographic data, admission reason, treatment modality, length of stay, mortality, and destination on discharge. Microsoft Excel was used for data collection and interpretation.
Results
150 patients were analysed, totalling 184 admissions over the study period. 73 patients (49%) were women and 77 (51%) were men, with a mean age of 70.9 years. 95 patients (63%) were on active cancer treatment, while 55 (37%) were receiving best supportive care (BSC). The commonest five tumour sites were lung (19.3%), GI (14%), breast (14%), genitourinary including prostate (14%), and hepatobiliary (13%). Of the 95 patients on active treatment, 71 (74.7%) were on systemic therapy, 9 (9.5%) on radiotherapy, and 15 patients (15.8%) on multimodality treatment.
The commonest causes of admission were infection (74/184, 40.2%), disease progression (19/184, 10.3%), and uncontrolled pain (9.3%). Median length of stay was 4 days. Of the 184 episodes, 140 patients (76.1%) were discharged to the community, 17 (9.2%) died in hospital, 7 (3.8%) were flagged for long term care, 15 (8.2%) were transferred to SAMOC for specialist Oncology and Palliative care, and 3 patients (1.6%) were transferred to other specialties.
Conclusion
This study demonstrates an alternative service design in a country with limited oncology and palliative care physician and specialist nurse workforce and no formal Acute Oncology or inpatient hospice services to date. Implementation of an Oncology Liaison Service aims to provide continuity of care for cancer patients led by General Internal Medicine consultants with a special interest in palliative and cancer care. This is especially beneficial in a cohort such as ours with a significant comorbidity burden and a long median length of stay of 4 days.
The service aims to expand with the recruitment of a specialist nurse and further consultants in the coming months. The present consultant cohort is composed of three respiratory specialists, but a stronger service is envisaged with recruitment of physicians from other specialties.
More data is required to demonstrate whether an OLS setup improves the patient experience, patient safety outcomes, and in-hospital mortality.
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