How does patient complexity differ between people with and without cancer who access specialist community palliative care? A comparative analysis study in Western Sydney specialist community palliative care

Introduction This study describes patient characteristics on entry and episode outcomes among patients admitted to an Australian community-based specialist palliative care service, comparing patients admitted with a cancer diagnosis with those admitted with a non-cancer diagnosis. Methods We conducted a comparative analysis of patients who were discharged from Specialist Community Palliative Care Service and received at least one episode of care between 1 July 2017 and 28 February 2023. We considered outcomes for socio-demographic characteristics, diagnoses and comorbidity burden, palliative care needs on admission to the service, episode duration and place of death. Results A total of 4116 distinct patients were included in the study. A quarter (26.0%) of the cohort were aged <65 years and almost half were culturally or linguistically diverse. Most (78.6%) were admitted with a cancer diagnosis, predominantly originating in the lung (23.1%, n=747), digestive system (21.3%, n=689) or genitourinary system (12.9%, n=418). Cardiovascular conditions were most common among patients admitted with non-cancer diagnosis (19.3%), followed by respiratory conditions (16.9%) and genitourinary conditions (13.9%). Dementia was present for 10.3% of patients with a non-cancer diagnosis on admission. Patients with a non-cancer diagnosis had more comorbidities (median=8 vs 5), they were more commonly frail and took more medications (median=7 vs 6) in comparison to patients with malignancy. On admission, patients with a non-cancer diagnosis had significantly lower functional scores for activities of daily living and were less likely to enter the service in a stable phase. However, patients with a non-cancer diagnosis were more likely to die at home and die in their preferred place compared with patients with cancer (p=<0.001). Conclusions Cancer and non-cancer cohorts of patients admitted to community palliative care services have different admission characteristics and service needs. Both groups have complex requirements, and further investment in palliative care should target optimal community-based models that positively influence early entry, patient-centred care and death in place of choice.